Predictive Value of Emergency Designation on Outcomes of Moribund Patients

TitlePredictive Value of Emergency Designation on Outcomes of Moribund Patients
Publication TypeJournal Article
Year of Publication2022
AuthorsTurnbull ZA, Tangel VE, Goldstein PA
Date Published07/15/2022
Keywordsasa ps (american society of anaesthesiology physical status), asa status, discharge disposition, length of hospital stay (los), perioperative mortality

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.

PubMed ID35978752
PubMed Central IDPMC9375848

Center for Perioperative Outcomes
NewYork-Presbyterian Hospital 
Weill Cornell Medical Center
428 East 72nd Street, Suite 800A
New York, NY 10021