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Impact of ASA score misclassification on NSQIP predicted mortality: a retrospective analysis
BACKGROUND: The ASA physical classification score has a major impact on the observed/expected (O/E) mortality ratio in the NSQIP General Vascular Mortality Model. The difference in predicted mortality is greatest between ASAs 3 and 4. We hypothesized under-classified ASA scores significantly affect...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725975/ https://www.ncbi.nlm.nih.gov/pubmed/29238570 http://dx.doi.org/10.1186/s13741-017-0076-1 |
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author | Helkin, Alex Jain, Sumeet V. Gruessner, Angelika Fleming, Maureen Kohman, Leslie Costanza, Michael Cooney, Robert N. |
author_facet | Helkin, Alex Jain, Sumeet V. Gruessner, Angelika Fleming, Maureen Kohman, Leslie Costanza, Michael Cooney, Robert N. |
author_sort | Helkin, Alex |
collection | PubMed |
description | BACKGROUND: The ASA physical classification score has a major impact on the observed/expected (O/E) mortality ratio in the NSQIP General Vascular Mortality Model. The difference in predicted mortality is greatest between ASAs 3 and 4. We hypothesized under-classified ASA scores significantly affect the O/E mortality. METHODS: We conducted a retrospective review of NSQIP essential surgery cases from January 2014 to December 2014 (n = 1264) with mortality sub-analysis (n = 33) at our institution. We recorded transfer and emergency status and independently calculated the ASA score for mortalities using published definitions. A random sample of 50 survivors and 10 emergency survivors were reviewed and ASA recalculated. We performed statistical modeling to simulate the effects of ASA misclassifications. Statistical analysis was performed using JMP 10 and SAS 9.4. RESULTS: ASA was under-classified in 18.2% of mortalities, most commonly ASAs 3 and 4. Sixteen percent of ASA 3 survivors were misclassified, including 60% in the emergency subgroup (p < 0.05 vs. elective cases). Patients transferred from other institutions were more likely to be emergency cases than non-transferred patients (43.5 vs. 7.84%, p < 0.05). Transferred patients had a higher proportion of ASAs 3–5 vs. ASAs 1–2 compared with non-transfers (84.38 vs. 49.76%, p < 0.05) Simulation data showed ASA misclassification underestimated predicted mortality by 2.5 deaths on average. CONCLUSION: ASA misclassification significantly impacts O/E mortality. With accurate ASA classification, observed mortality would not have exceeded expected mortality in our institution. Education regarding the impact of ASA scoring is critical to ensure accurate O/E mortality data at hospitals using NSQIP to assess surgical quality. |
format | Online Article Text |
id | pubmed-5725975 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-57259752017-12-13 Impact of ASA score misclassification on NSQIP predicted mortality: a retrospective analysis Helkin, Alex Jain, Sumeet V. Gruessner, Angelika Fleming, Maureen Kohman, Leslie Costanza, Michael Cooney, Robert N. Perioper Med (Lond) Research BACKGROUND: The ASA physical classification score has a major impact on the observed/expected (O/E) mortality ratio in the NSQIP General Vascular Mortality Model. The difference in predicted mortality is greatest between ASAs 3 and 4. We hypothesized under-classified ASA scores significantly affect the O/E mortality. METHODS: We conducted a retrospective review of NSQIP essential surgery cases from January 2014 to December 2014 (n = 1264) with mortality sub-analysis (n = 33) at our institution. We recorded transfer and emergency status and independently calculated the ASA score for mortalities using published definitions. A random sample of 50 survivors and 10 emergency survivors were reviewed and ASA recalculated. We performed statistical modeling to simulate the effects of ASA misclassifications. Statistical analysis was performed using JMP 10 and SAS 9.4. RESULTS: ASA was under-classified in 18.2% of mortalities, most commonly ASAs 3 and 4. Sixteen percent of ASA 3 survivors were misclassified, including 60% in the emergency subgroup (p < 0.05 vs. elective cases). Patients transferred from other institutions were more likely to be emergency cases than non-transferred patients (43.5 vs. 7.84%, p < 0.05). Transferred patients had a higher proportion of ASAs 3–5 vs. ASAs 1–2 compared with non-transfers (84.38 vs. 49.76%, p < 0.05) Simulation data showed ASA misclassification underestimated predicted mortality by 2.5 deaths on average. CONCLUSION: ASA misclassification significantly impacts O/E mortality. With accurate ASA classification, observed mortality would not have exceeded expected mortality in our institution. Education regarding the impact of ASA scoring is critical to ensure accurate O/E mortality data at hospitals using NSQIP to assess surgical quality. BioMed Central 2017-12-11 /pmc/articles/PMC5725975/ /pubmed/29238570 http://dx.doi.org/10.1186/s13741-017-0076-1 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Helkin, Alex Jain, Sumeet V. Gruessner, Angelika Fleming, Maureen Kohman, Leslie Costanza, Michael Cooney, Robert N. Impact of ASA score misclassification on NSQIP predicted mortality: a retrospective analysis |
title | Impact of ASA score misclassification on NSQIP predicted mortality: a retrospective analysis |
title_full | Impact of ASA score misclassification on NSQIP predicted mortality: a retrospective analysis |
title_fullStr | Impact of ASA score misclassification on NSQIP predicted mortality: a retrospective analysis |
title_full_unstemmed | Impact of ASA score misclassification on NSQIP predicted mortality: a retrospective analysis |
title_short | Impact of ASA score misclassification on NSQIP predicted mortality: a retrospective analysis |
title_sort | impact of asa score misclassification on nsqip predicted mortality: a retrospective analysis |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725975/ https://www.ncbi.nlm.nih.gov/pubmed/29238570 http://dx.doi.org/10.1186/s13741-017-0076-1 |
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