Predictive Value of Emergency Designation on Outcomes of Moribund Patients

Abstract

Background: Anesthesiologists are increasingly encountering sicker patients that require potentially life-saving surgical interventions, and assess risk using the American Society of Anesthesiology Physical Status (ASA PS) classification system. Here, we examined long-term mortality along with hospital length of stay (LoS) and discharge disposition for survivors in ASA PS 5 and 5E patients.

Methods: Adult surgeries were extracted from New York-Presbyterian Hospital/Weill Cornell Medical Center's Electronic Medical Record (EMR) for cases between January 1, 2013 and December 31, 2017; outcomes were collected from EMRs and the Social Security Death Index Master File.

Results: 194,947 cases were identified. Mortality correlated with increasing ASA PS; the same trend was observed within both emergent and non-emergent sub-populations. Two hundred seventy-six cases were identified as 5/5E. This patient population had a higher rate of mortality at 30 days than at 48 hours (25.9% vs. 13.4%, respectively, p < 0.01); there was no difference between survivor functions at 30 or 90 days (p = 0.63, p = 0.09, respectively). Survivors within the 5 or 5E subpopulations did not have significantly different LoSs. Further, survivors after 90 days typically had a disposition of hospice, long-term facilities, inpatient rehabilitation, or self-discharged.

Conclusions: Mortality increases with increases in ASA PS classifications. There is no difference in outcomes for 5 vs 5E at 30- or 90-day postoperatively. Similarly, emergency status did not play a role in LoS. Most 5 or 5E patients are not discharged home but to another facility. These outcomes should be considered during the informed consent process in this high-risk surgical population.

Keywords: asa ps ( american society of anaesthesiology physical status); asa status; discharge disposition; length of hospital stay (los); perioperative mortality.

Figure 1. Distribution of ASA status by emergency status.

ASA PS = American Society of Anesthesiologists Physical Status.

Figure 2. Kaplan-Meier survival curves for ASA PS 5 at 30 and 90 days postoperatively, by emergency status.

Vertical lines identify 30- and 90-day time points. Y-axis represents the proportion of each population surviving, by day. ASA PS = American Society of Anesthesiologists Physical Status.

Figure 3. Discharge disposition of all ASA PS 5/5E patients.

POD = postoperative day; ASA PS = American Society of Anesthesiologists Physical Status.