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Fitness plus A merican S ociety of A nesthesiologists grade improve outcome prediction after endovascular aneurysm repair
Author(s) -
Boult Margaret,
Cowled Prue,
Barnes Mary,
Fitridge Robert A.
Publication year - 2017
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14106
Subject(s) - medicine , aneurysm , overall survival , surgery
Background Although the American Society of Anesthesiologists ( ASA ) grade was established for statistical purposes, it is often used prognostically. However, older patients undergoing elective surgery are typically ASA III , which limits patient stratification. We look at the prognostic effect on early complications and survival of using ASA and self‐reported physical fitness to stratify patients undergoing endovascular repair of abdominal aortic aneurysms. Methods Data were extracted from a trial database. All patients were assigned a fitness level (A (fit) or B (unfit)) based on their self‐reported ability to walk briskly for 1 km or climb two flights of stairs. Fitness was used to stratify ASA III patients, with fitter patients assigned ASA IIIA and less fit patients ASA IIIB . Outcomes assessed included survival, reinterventions, endoleak, all early and late complications and early operative complications. Results A combined ASA /fitness scale ( II , IIIA , IIIB and IV ) correlated with 1‐ and 3‐year survival (1‐year P = 0.001, 3‐year P = 0.001) and early and late complications ( P = 0.001 and P = 0.05). On its own, ASA predicted early complications ( P = 0.0004) and survival (1‐year P = 0.01, 3‐year P = 0.01). Fitness alone was predictive for survival (1‐year P = 0.001, 3‐year P = 0.001) and late complications ( P = 0.009). Conclusion This study shows that even a superficial assessment of fitness is reflected in surgical outcomes, with fitter ASA III patients showing survival patterns similar to ASA II patients. Physicians should be alert to differences in fitness between patients in the ASA III group, despite similarities based on preexisting severe systemic disease.