Perioperative risk stratification in patients undergoing multi-resection surgeries. Is ASA classification sufficient?

Abstract

Background. As of today, there are no protocols for managing surgical patients with comorbidities. Therefore, the issue of perioperative management of high-risk surgical patients is very relevant, holds significant importance for practical medicine, and requires further study. One of the most popular tools for perioperative risk stratification remains the American Society of Anesthesiologists (ASA) classification. The purpose of the study was to assess the impact of the severity of surgical disease and the extent of surgery on the prognostic ability of the ASA assessment. Materials and methods. The retrospective study included 240 patients with ASA II, divided into 2 groups based on the extent of surgical intervention. Results. Correlation analysis revealed a strong positive linear relationship (r = 0.89, p < 0.001) between the duration of stay in the intensive care unit, the frequency of recurrent admissions to the intensive care unit within the same hospitalization, mortality, the total duration of hospitalization and the extent of surgical intervention. Furthermore, a strong positive correlation (r = 0.82, p < 0.001) was found between the severity of systemic disease spread and the extent of surgical intervention. A moderate positive correlation (r = 0.54, p < 0.001) was observed between the duration of surgical intervention and postoperative complications such as thromboembolism, anastomotic insufficiency, bronchopulmonary, urinary tract infection, as well as a strong positive linear relationship with postoperative wound infection. Conclusions. The frequency, nature of postoperative complications, and duration of hospitalization were significantly influenced by the severity of surgical pathology and the extent of surgical intervention. The ASA classification is a subjective tool for assessing mortality and has inadequate prognostic ability regarding the frequency of postoperative complications.

Keywords

• asa
• preoperative risk stratification
• improvement of risk stratification quality
• high-risk perioperative complication patients