Modeling Perioperative Risk: Can Numbers Speak Louder Than Words?
Section snippets
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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Cited by (10)
Perioperative care of patients with rheumatic disease
2015, Rheumatology: Sixth EditionCriteria for the request of preoperative tests among oral and maxillofacial surgeons
2012, Journal of Cranio-Maxillofacial SurgeryCitation Excerpt :According to Klein and Arrowsmith (2010), current guidelines recommend routine preoperative tests depending on the patients’ age, pre-existing conditions, type and complexity of the proposed surgery and physical status based on the ASA classification. According to Holt and Silverman (2006), despite the limitations and subjectivity of the ASA physical status classification system remains the most often used classification system. According to Fattahi (2006), familiarity with the ASA classification is critical to the preoperative assessment of the patient.
Preoperative evaluation
2011, Revista Medica Clinica Las CondesIntegrated Assessment and Consultation for the Preoperative Patient
2009, Anesthesiology ClinicsCitation Excerpt :pain management, and conditions which, although not necessarily of major impact during daily life, may pose a disproportionate risk during the perioperative period unless assessed and planned for appropriately (discussed later). In recent years, members of the authors' preoperative assessment team have described a means for uniform grading of existing patient morbidities as well as anticipated perioperative disturbances,25,41 thereby facilitating generation of an integrated existing morbidity and anticipated disturbance matrix that tabulates a patient's risk profile. Its foundation is the application of the overall 1 to 5 ASA physical status score on a system-by-system basis or, when added specificity is deemed indicated on a subsystem or disorder basis (Table 1).
Integrated Assessment and Consultation for the Preoperative Patient
2009, Medical Clinics of North AmericaCitation Excerpt :pain management, and conditions which, although not necessarily of major impact during daily life, may pose a disproportionate risk during the perioperative period unless assessed and planned for appropriately (discussed later). In recent years, members of the authors' preoperative assessment team have described a means for uniform grading of existing patient morbidities as well as anticipated perioperative disturbances,25,41 thereby facilitating generation of an integrated existing morbidity and anticipated disturbance matrix that tabulates a patient's risk profile. Its foundation is the application of the overall 1 to 5 ASA physical status score on a system-by-system basis or, when added specificity is deemed indicated on a subsystem or disorder basis (Table 1).
Some of the material included herein is also included in a pending patent (D.G. Silverman).