Utilization of the American Society of Anesthesiologists (ASA) classification system in evaluating outcomes and costs following deformity spine procedures

Alexander J. Schupper, William H. Shuman, Rebecca B. Baron, Sean N. Neifert, Emily K. Chapman, Jeffrey Gilligan, Jonathan S. Gal, John M. Caridi

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Purpose: Adult spinal deformity (ASD) has increased prevalence in aging populations. Due to the high cost of surgery, studies have evaluated risk factors that predict readmissions and poor outcomes. The American Society of Anesthesiologists (ASA) classification system has been applied to patients with ASD to assess preoperative health and assess the correlation between ASA class and postoperative complications. This study evaluates the relationship between ASA and complications, length of stay (LOS), and direct costs following spine deformity surgery. Methods: Patients undergoing spine deformity surgery at a single institution from 2008–2016 were included and stratified based upon ASA status. Primary outcomes included patient demographics, adjusted LOS, and cost of care. Secondary measures compared between cohorts included adverse events, non-home discharge, and readmission rates. Results: 442 patients with ASD were included in this study. Higher ASA class was correlated with greater Elixhauser Comorbidity Index (ECI) scores (p < 0.0001) and older age (p < 0.0001). Univariate analysis showed longer LOS (p < 0.0001) and greater direct costs in patients with higher ASA class (p < 0.0001). Patients in ASA Class III or IV had the greatest incidence of ICU stay when compared to patients without systemic disease (p < 0.0001). Upon multivariable regression analysis, high ASA class was associated with higher rates of non-home discharge (OR 5.0, 95% CI 3.1–8.1). Direct costs were greater for higher ASA class (regression estimate = + $9,666, p = 0.002). Conclusion: This study demonstrates that ASA class is correlated with a more complicated postoperative hospital course, greater rates of non-home discharge, total direct costs in spine deformity patients.

Original languageEnglish
Pages (from-to)185-190
Number of pages6
JournalSpine Deformity
Volume9
Issue number1
DOIs
StatePublished - Jan 2021
Externally publishedYes

Keywords

  • ASA status
  • Spine deformity
  • Spine outcomes
  • Spine surgery

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