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Predictive Value of Emergency Designation on Outcomes of Moribund Patients

Background: Anesthesiologists are increasingly encountering sicker patients that require potentially life-saving surgical interventions, and assess risk using the American Society of Anesthesiology Physical Status (ASA PS) classification system. Here, we examined long-term mortality along with hospi...

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Autores principales: Turnbull, Zachary A, Tangel, Virginia E, Goldstein, Peter A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9375848/
https://www.ncbi.nlm.nih.gov/pubmed/35978752
http://dx.doi.org/10.7759/cureus.26875
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author Turnbull, Zachary A
Tangel, Virginia E
Goldstein, Peter A
author_facet Turnbull, Zachary A
Tangel, Virginia E
Goldstein, Peter A
author_sort Turnbull, Zachary A
collection PubMed
description Background: Anesthesiologists are increasingly encountering sicker patients that require potentially life-saving surgical interventions, and assess risk using the American Society of Anesthesiology Physical Status (ASA PS) classification system. Here, we examined long-term mortality along with hospital length of stay (LoS) and discharge disposition for survivors in ASA PS 5 and 5E patients. Methods: Adult surgeries were extracted from New York-Presbyterian Hospital/Weill Cornell Medical Center’s Electronic Medical Record (EMR) for cases between January 1, 2013 and December 31, 2017; outcomes were collected from EMRs and the Social Security Death Index Master File. Results: 194,947 cases were identified. Mortality correlated with increasing ASA PS; the same trend was observed within both emergent and non-emergent sub-populations. Two hundred seventy-six cases were identified as 5/5E. This patient population had a higher rate of mortality at 30 days than at 48 hours (25.9% vs. 13.4%, respectively, p < 0.01); there was no difference between survivor functions at 30 or 90 days (p = 0.63, p = 0.09, respectively). Survivors within the 5 or 5E subpopulations did not have significantly different LoSs. Further, survivors after 90 days typically had a disposition of hospice, long-term facilities, inpatient rehabilitation, or self-discharged. Conclusions: Mortality increases with increases in ASA PS classifications. There is no difference in outcomes for 5 vs 5E at 30- or 90-day postoperatively. Similarly, emergency status did not play a role in LoS. Most 5 or 5E patients are not discharged home but to another facility. These outcomes should be considered during the informed consent process in this high-risk surgical population.
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spelling pubmed-93758482022-08-16 Predictive Value of Emergency Designation on Outcomes of Moribund Patients Turnbull, Zachary A Tangel, Virginia E Goldstein, Peter A Cureus Anesthesiology Background: Anesthesiologists are increasingly encountering sicker patients that require potentially life-saving surgical interventions, and assess risk using the American Society of Anesthesiology Physical Status (ASA PS) classification system. Here, we examined long-term mortality along with hospital length of stay (LoS) and discharge disposition for survivors in ASA PS 5 and 5E patients. Methods: Adult surgeries were extracted from New York-Presbyterian Hospital/Weill Cornell Medical Center’s Electronic Medical Record (EMR) for cases between January 1, 2013 and December 31, 2017; outcomes were collected from EMRs and the Social Security Death Index Master File. Results: 194,947 cases were identified. Mortality correlated with increasing ASA PS; the same trend was observed within both emergent and non-emergent sub-populations. Two hundred seventy-six cases were identified as 5/5E. This patient population had a higher rate of mortality at 30 days than at 48 hours (25.9% vs. 13.4%, respectively, p < 0.01); there was no difference between survivor functions at 30 or 90 days (p = 0.63, p = 0.09, respectively). Survivors within the 5 or 5E subpopulations did not have significantly different LoSs. Further, survivors after 90 days typically had a disposition of hospice, long-term facilities, inpatient rehabilitation, or self-discharged. Conclusions: Mortality increases with increases in ASA PS classifications. There is no difference in outcomes for 5 vs 5E at 30- or 90-day postoperatively. Similarly, emergency status did not play a role in LoS. Most 5 or 5E patients are not discharged home but to another facility. These outcomes should be considered during the informed consent process in this high-risk surgical population. Cureus 2022-07-15 /pmc/articles/PMC9375848/ /pubmed/35978752 http://dx.doi.org/10.7759/cureus.26875 Text en Copyright © 2022, Turnbull et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Anesthesiology
Turnbull, Zachary A
Tangel, Virginia E
Goldstein, Peter A
Predictive Value of Emergency Designation on Outcomes of Moribund Patients
title Predictive Value of Emergency Designation on Outcomes of Moribund Patients
title_full Predictive Value of Emergency Designation on Outcomes of Moribund Patients
title_fullStr Predictive Value of Emergency Designation on Outcomes of Moribund Patients
title_full_unstemmed Predictive Value of Emergency Designation on Outcomes of Moribund Patients
title_short Predictive Value of Emergency Designation on Outcomes of Moribund Patients
title_sort predictive value of emergency designation on outcomes of moribund patients
topic Anesthesiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9375848/
https://www.ncbi.nlm.nih.gov/pubmed/35978752
http://dx.doi.org/10.7759/cureus.26875
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