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Is the American Society of Anesthesiologists classification useful in risk stratification for endoscopic procedures?

The latest issue of the Gastrointestinal Endoscopy investigates whether the American Society of Anesthesiologists classification is useful in risk stratification for endoscopic procedures.

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The American Society of Anesthesiologists physical status classification is a measurement of comorbidity and a predictor of perioperative morbidity and mortality.

Dr Brintha Enestvedt and colleagues from Pennsylvania, USA assessed the predictive ability of the American Society of Anesthesiologists class for periendoscopic adverse events.

The research team evaluated a total of 74 sites in the United States comprising academic, community/health maintenance organization, and Veterans Affairs/military practices affiliated with the Clinical Outcomes Research Initiative database.

Patients who were 18 years or older who underwent an endoscopic procedure between 2000 and 2008, including EGD, colonoscopy, flexible sigmoidoscopy, and ERCP.

Immediate adverse event requiring an unplanned intervention.

Immediate adverse event occurred in about 0.4% of all endoscopic procedures
Gastrointestinal Endoscopy

The research team assessed that a total of 1,590,648 endoscopic procedures were performed on 1,318,495 individual patients.

The majority of patients were designated as  American Society of Anesthesiologists class I or II.

The doctors assessed that an immediate adverse event occurred in about 0.4% of all endoscopic procedures and was proportionally highest for ERCPs.

Increasing American Society of Anesthesiologists class was associated with higher prevalence and a stepwise increase in the odds ratio of serious adverse events for EGD, and colonoscopy.

The research team assessed that this trend was not significant for flexible sigmoidoscopy and ERCP.

Dr Enestvedt's team concluded, "The American Society of Anesthesiologists class is associated with increased risk of adverse events at endoscopy, particularly for EGD and colonoscopy."

"It is useful in endoscopic risk stratification and an important quality indicator for endoscopy."

Gastrointestinal Endoscopy 2013: 77(3): 464-471
21 March 2013

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