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A Higher American Society of Anesthesiologists Classification Does Not Correlate With Inferior Outcomes Following
Shriya N Patel1, Sloane O Ward1, Nathaniel S Cohen2
1Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Study Design:
Retrospective review.
Objective:
To analyze the impact of American Society of Anesthesiologists (ASA) classification on Patient-Reported Outcome Measurement Information System (PROMIS) outcomes following Cervical Disc Replacement (CDR).
Summary Of Background Data:
The ASA classification facilitates the categorization of patient health and operation risk. It is well-established that ASA classification is an important consideration when weighing the risks and benefits of surgery and anesthesia. ASA classification may also correlate with patient-reported outcomes (PROs) following spine surgery.
Methods:
Patient information from a single spine surgeon's database was retrospectively analyzed. Two cohorts were formed based on ASA classification: <2 being"Lower ASA," and scores of 2 or greater being "Higher ASA." Demographic data, perioperative characteristics, and PROs were compared between the two groups, and outcome measures were examined at various time points. Changes of PROs over time and minimum clinically important difference (MCID) achievement was also analyzed.
Results:
A total of129 patients met inclusion criteria, with 27 patients in the lower ASA cohort and 102 in the higher ASA group. Patients with higher ASA scores had significantly greater age, body mass index (BMI), hypertension, Charlson Comorbidity Index (CCI), and foraminal stenosis rates (P<0.025) (Tables 1 and 2, P<0.025 for all). Preoperatively, the PROs did not differ between cohorts. Patients in the higher ASA score group had greater PROMIS-Physical Function (PROMIS-PF) scores at the 6-week follow-up, and lower Visual Analog Scale Arm (VAS-A) scores at final follow-up. Although changes in outcome measures differed for certain PROs, this did not impact overall MCID achievement difference among cohorts.
Conclusions:
In patients undergoing elective CDR, more patients with higher ASA classification hadhigher physical function scores at short-term follow-up and lower arm pain at longer term follow-up. These findings suggest thathigher ASA score does not necessarily correlate with worse postoperative outcomes in elective CDR.
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