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The Association Between ASA Status and Other Risk Stratification Models on Postoperative Intensive Care Unit Outcomes

Lupei, Monica I. MD*; Chipman, Jeffrey G. MD; Beilman, Gregory J. MD; Oancea, S. Cristina PhD; Konia, Mojca R. MD, PhD§

doi: 10.1213/ANE.0000000000000187
Critical Care, Trauma, and Resuscitation: Research Report

BACKGROUND: There is limited medical literature investigating the association between perioperative risk stratification methods and surgical intensive care unit (SICU) outcomes. Our hypothesis contends that routine assessments such as higher ASA physical status classification, surgical risk as defined by American College of Cardiology/American Heart Association guidelines, and simplified Revised Cardiac Index (SRCI) can reliably be associated with SICU outcomes.

METHODS: We performed a chart review of all patients 18 years or older admitted to the SICU between October 1, 2010, and March 1, 2011. We collected demographic and preoperative clinical data: age, sex, ASA physical status class, surgical risk, and SRCI. Outcome data included our primary end point, SICU length of stay, and secondary end points: mechanical ventilation and vasopressor treatment duration, number of acquired organ dysfunctions (NOD), readmission to the intensive care unit (ICU) within 7 days, SICU mortality, and 30-day mortality. Regression analysis and nonparametric tests were used, and P < 0.05 was considered significant.

RESULTS: We screened 239 patients and included 220 patients in the study. The patients’ mean age was 58 ± 16 years. There were 32% emergent surgery and 5% readmissions to the SICU within 7 days. The SICU mortality and the 30-day mortality were 3.2%. There was a significant difference between SICU length of stay (2.9 ± 2.1 vs 5.9 ± 7.4, P = 0.007), mechanical ventilation (0.9 ± 2.0 vs 3.4 ± 6.8, P = 0.01), and NOD (0 [0–2] vs 1 [0–5], P < 0.001) based on ASA physical status class (≤ 2 vs ≥ 3). Outcomes significantly associated with ASA physical status class after adjusting for confounders were: SICU length of stay (incidence rate ratio [IRR] = 1.79, 95% confidence interval [CI], 1.35–2.39, P < 0.001), mechanical ventilation (IRR = 2.57, 95% CI, 1.69–3.92, P < 0.001), vasopressor treatment (IRR = 3.57, 95% CI, 1.84–6. 94, P < 0.001), NOD (IRR = 1.71, 95% CI, 1.46–1.99, P < 0.001), and readmission to ICU (odds ratio = 3.39, 95% CI, 1.04–11.09, P = 0.04). We found significant association between surgery risk and NOD (IRR = 1.56, 95% CI, 1.29–1.89, P < 0.001, and adjusted IRR = 1.31, 95% CI, 1.05–1.64, P = 0.02). SRCI was not significantly associated with SICU outcomes.

CONCLUSIONS: Our study revealed that ASA physical status class is associated with increased SICU length of stay, mechanical ventilation, vasopressor treatment duration, NOD, readmission to ICU, and surgery risk is associated with NOD.

From the *Anesthesiology Critical Care Medicine Department, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Surgery Department, University of Minnesota School of Medicine, Minneapolis, Minnesota; Master of Public Health Program, Department of Family & Community Medicine, University of North Dakota, Grand Forks, North Dakota; and §Anesthesiology Department, University of Minnesota School of Medicine, Minneapolis, Minnesota.

Funding: Not applicable.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Monica I. Lupei, MD, Anesthesiology Critical Care Medicine Department, University of Minnesota, B515 Mayo Memorial Building, 420 Delaware St., SE Minneapolis, MN 55455. Address e-mail to

© 2014 International Anesthesia Research Society