Document Detail


Is the American Society of Anesthesiologists classification useful in risk stratification for endoscopic procedures?
MedLine Citation:
PMID:  23410699     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The American Society of Anesthesiologists (ASA) physical status classification is a measurement of comorbidity and a predictor of perioperative morbidity and mortality.
OBJECTIVE: To assess the predictive ability of the ASA class for periendoscopic adverse events.
DESIGN: Retrospective cohort analysis.
SETTING: A total of 74 sites in the United States comprising academic, community/health maintenance organization, and Veterans Affairs/military practices affiliated with the Clinical Outcomes Research Initiative (CORI) database.
PATIENTS: Patients who were 18 years or older who underwent an endoscopic procedure between 2000 and 2008.
INTERVENTIONS: EGD, colonoscopy, flexible sigmoidoscopy, and ERCP.
MAIN OUTCOME MEASUREMENTS: Immediate adverse event requiring an unplanned intervention.
RESULTS: A total of 1,590,648 endoscopic procedures were performed on 1,318,495 individual patients. The majority of patients were designated as ASA class I or II (I: 27%, II: 63%). An immediate adverse event occurred in 0.35% of all endoscopic procedures (n = 5596) and was proportionally highest for ERCPs (1.84%). Increasing ASA class was associated with higher prevalence and a stepwise increase in the odds ratio of serious adverse events for EGD (II: 1.54 [95% confidence interval (CI), 1.31-1.82]; III: 3.90 [95% CI, 3.27-4.64]; IV/V: 12.02 [95% CI, 9.62-15.01]); and colonoscopy (II: 0.92 [95% CI, 0.85-1.01]; III: 1.66 [95% CI, 1.46-1.87]; IV/V: 4.93 [95% CI, 3.66-66.3]). This trend was not significant for flexible sigmoidoscopy and ERCP.
LIMITATIONS: Retrospective; endpoint was a surrogate for periprocedure morbidity.
CONCLUSIONS: ASA class is associated with increased risk of adverse events at endoscopy, particularly for EGD and colonoscopy. It is useful in endoscopic risk stratification and an important quality indicator for endoscopy.
Authors:
Brintha K Enestvedt; Glenn M Eisen; Jennifer Holub; David A Lieberman
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  77     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-15     Completed Date:  2013-09-13     Revised Date:  2014-03-06    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  464-71     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anesthesiology
Cholangiopancreatography, Endoscopic Retrograde / adverse effects*,  statistics & numerical data
Colonoscopy / adverse effects,  statistics & numerical data
Confidence Intervals
Emergency Service, Hospital / statistics & numerical data
Endoscopy, Gastrointestinal / adverse effects*,  statistics & numerical data
Female
Health Status Indicators*
Hospitalization / statistics & numerical data
Humans
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Predictive Value of Tests
Retrospective Studies
Risk Assessment / methods
Societies, Medical
Grant Support
ID/Acronym/Agency:
R21 CA131626/CA/NCI NIH HHS; R33 DK061778/DK/NIDDK NIH HHS; U01 DK057132/DK/NIDDK NIH HHS; U01DK57132/DK/NIDDK NIH HHS
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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