Modeling Perioperative Risk: Can Numbers Speak Louder Than Words?

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The American Society of Anesthesiologists Physical Status Classification System

In the early 1940s, the American Society of Anesthesiologists (ASA) had the wisdom to design a simple score that would enable anesthesiologists to communicate the severity of a patient's illness among themselves and with physicians in other specialties. One of the stated purposes was to develop a means by which to develop statistical data about anesthetic outcomes that appropriately controlled for differences in patients' underlying medical conditions [14]. Sixty years later—with only minor

Proposed model of perioperative risk assessment and communication

In light of this discussion, the authors have developed a multidimensional model of perioperative risk that incorporates: a score for the physical condition of the patient, a score for the degree of expected surgical risk and invasiveness, scores relating to mask ventilation and intubation, and letter codes for special “risk indicators” that may require tailored preparation and planning.

Where possible, the authors have related their score to means of ranking familiar to clinicians—particularly

Applications of an integrated system

From a patient-care standpoint the goal of an integrated system such as SHAPE™ is to facilitate the categorization and communication of large amounts of information, highlight potentially high-risk situations, guide perioperative planning, and provide a means by which to analyze outcomes. Fig. 1 illustrates how the ASPIRIN™ display may be coded on an operating room schedule; a given case could range from “1,1,0,0” to “5,5,5,5,A,B,C,Dx,E,I,J,L,O,P,T,W” (with the potential for further delineation

Summary

Perioperative care is one of the most complex segments of medicine, because it imposes unique and unprecedented stress on the patient and requires the participation of multiple medical specialists. For this reason, the concept of risk management is ideally suited for application in the perioperative period. The authors believe that risk stratification systems applied to perioperative management should address the three dimensions of patient condition, surgical risk and invasiveness, and

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    Some of the material included herein is also included in a pending patent (D.G. Silverman).

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