From the Guidelines
Patients with higher ASA grades (III-V) have substantially higher 3-day mortality rates compared to those with lower grades (I-II), with mortality rates increasing significantly with each ASA grade increment 1.
Background
The American Society of Anesthesiologists (ASA) physical status classification is a widely used system to assess a patient's physical health before surgery.
- The classification system ranges from ASA I (healthy patient) to ASA V (moribund patient).
- Studies have shown that ASA grade is a strong predictor of postoperative mortality, with higher grades associated with increased mortality rates.
Evidence
A study published in the World Journal of Emergency Surgery in 2023 found that patients with ASA physical status III or more had a higher odds ratio of requiring reintubation within the first 3 days after primary extubation, which was associated with a 72-fold increase in in-hospital death 1.
- Another study found that preoperative ASA score was significantly predictive of length of stay and cumulative morbidity in patients who underwent emergency laparotomy 1.
- The study also found that complications were more common in patients over the age of 80 years, and that cardiovascular and renal complications on any postoperative day were highly predictive of mortality.
Survival Rate
While the exact 3-day survival rate is not specified in the provided evidence, it is clear that patients with higher ASA grades have a higher risk of mortality and complications after surgery.
- The 3-day mortality rate increases significantly with each ASA grade increment, with patients with higher ASA grades (III-V) having substantially higher mortality rates compared to those with lower grades (I-II) 1.
- Clinicians should use the ASA grading system to identify high-risk patients who may benefit from enhanced monitoring and care in the immediate postoperative period.
Management
Early detection and management of complications are crucial to improving outcomes in patients who have undergone emergency laparotomy.
- The use of track and trigger physiological scoring systems, such as the early warning score, can help identify patients who are at risk of developing complications 1.
- Rapid response teams, including an intensivist experienced in management of postoperative surgical patients, have shown benefit in reducing failure to rescue and improving outcomes 1.
From the Research
Survival Rate 3 Days Post-Surgery Based on ASA Physical Status Classification
- The provided studies do not directly report the survival rate 3 days post-surgery based on the American Society of Anesthesiologists (ASA) physical status classification.
- However, study 2 reports postoperative morbidity on postoperative days 3,7, and 10, but does not provide specific survival rates.
- Study 3 reports odds ratios for complications and mortality at increasing levels of ASA-PS, but does not provide specific survival rates at 3 days post-surgery.
- Study 4 reports 30-day medical complications and mortality for outpatient surgeries, but does not provide specific survival rates at 3 days post-surgery.
- Study 5 reports 30-day survival rates for vascular surgery patients based on ASA class and functional status, but does not provide specific survival rates at 3 days post-surgery.
- Study 6 reports the association between ASA class and postoperative outcomes, including mortality, following adult spinal deformity surgery, but does not provide specific survival rates at 3 days post-surgery.
ASA Physical Status Classification and Postoperative Outcomes
- The ASA physical status classification is a reliable independent predictor of medical complications and mortality following surgery 3, 4, 6.
- The classification system can be used to identify high-risk surgical populations concerning postoperative morbidity and mortality before surgery 2, 5.
- The ASA classification system has strong, independent associations with post-operative medical complications and mortality across procedures 3.