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Impact of ASA score misclassification on NSQIP predicted mortality: a retrospective analysis

Overview of attention for article published in Perioperative Medicine, December 2017
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Title
Impact of ASA score misclassification on NSQIP predicted mortality: a retrospective analysis
Published in
Perioperative Medicine, December 2017
DOI 10.1186/s13741-017-0076-1
Pubmed ID
Authors

Alex Helkin, Sumeet V. Jain, Angelika Gruessner, Maureen Fleming, Leslie Kohman, Michael Costanza, Robert N. Cooney

Abstract

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. 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. 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. 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.

Twitter Demographics

The data shown below were collected from the profile of 1 tweeter who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 14 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 14 100%

Demographic breakdown

Readers by professional status Count As %
Researcher 2 14%
Student > Bachelor 2 14%
Other 2 14%
Student > Doctoral Student 1 7%
Lecturer 1 7%
Other 5 36%
Unknown 1 7%
Readers by discipline Count As %
Medicine and Dentistry 9 64%
Unspecified 2 14%
Nursing and Health Professions 1 7%
Unknown 2 14%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 13 December 2017.
All research outputs
#9,817,919
of 12,292,436 outputs
Outputs from Perioperative Medicine
#88
of 112 outputs
Outputs of similar age
#246,225
of 344,918 outputs
Outputs of similar age from Perioperative Medicine
#7
of 9 outputs
Altmetric has tracked 12,292,436 research outputs across all sources so far. This one is in the 11th percentile – i.e., 11% of other outputs scored the same or lower than it.
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