Introduction: Patients classified as American Society of Anesthesiologists (ASA) physical status 5 (ASA5) are described as “a moribund patient who is not expected to survive without the operation.” We wished to describe the outcomes of ASA5 patients who underwent neurosurgery and to identify risk factors for adverse outcomes.
Methods: We used the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify 147 ASA5 patients who underwent neurological surgery between 2006 and 2011. Univariate logistic regression was used to identify baseline factors associated with adverse post-operative outcomes and all factors identified were incorporated into the final multivariate models.
Results: Seventy percent of all patients experienced one or more complications; postoperative ventilator-assisted respiration of greater than 48 hours was the most common complication (57% of patients). Thirty-day mortality was 38.8%. Obesity was a significant risk factor for prolonged length of hospitalization (LOS), increasing the odds by 3.6 (95% CI 1.2-11.5) compared with normal body weight. Minority race and pulmonary comorbidities were associated with 4.0 (95% CI 1.5-10.5) and 3.4 (95% CI 1.3-8.8) times the odds for any postoperative complications, respectively.
Conclusions: This is the first study to describe the outcomes of ASA5 patients who undergo neurosurgery and to identify risk factors for adverse outcomes. While there was an overall complication rate of 70% in these critically-ill patients, 90% of whom underwent emergency surgery, only 38.8% died within 30 days of surgery. Obesity was associated with increased risk for prolonged LOS, while minority race and preoperative pulmonary disease increased the odds for experiencing one or more postoperative complication. Our findings, using a large multi-institutional sample of prospectively-collected data, suggest that ASA5 patients who undergo neurosurgery have a reasonable change of survival. These novel findings may inform decision-making in critically-ill neurosurgical patients.
Patient Care: Our findings suggest that ASA5 patients who undergo neurosurgery have a reasonable change of survival. These novel findings may inform decision-making in critically-ill neurosurgical patients.
Learning Objectives: By the conclusion of this session, the participants should be able to 1) describe the outcomes of ASA5 patients, who underwent neurosurgery, 2) identify risk factors for adverse outcomes in ASA5 patients who undergo neurosurgery.