Implication of American Society of Anesthesiologists Physical Status (ASA-PS) on tonsillectomy with or without adenoidectomy outcomes

Background: The American Society of Anesthesiologists Physical status classification (ASA-PS) is a simple categorization of a patient's physiological status during the perioperative period. The role of ASA-PS in predicting operative risk and complications following tonsillectomy with or without adenoidectomy (T +/- A) has not been studied. The objective of the study was to identify the association of the pre-operative ASA-PS with 30-day complication rates and adverse events following T +/- A. Study design: A retrospective analysis was performed using data from the American College of Surgeons' National Surgical Quality Improvement Program database (ACS NSQIP) of patients aged 16 years or older who underwent T +/- A between 2005 and 2016. Patients were stratified into ASA-PS Classes I/II and III/IV. Patient demographics, preoperative comorbidities, pre-operative laboratory values, operation-specific variables, and postoperative outcomes in the 30-day period following surgery were compared between the two subsets of ASA-PS groups. Results: On multivariate analysis, patients with ASA class III and IV were more likely to experience an unplanned readmission (OR 1.39, 95 % CI 1.09-1.76; p = 0.007), overall complications (OR 1.49, 95 % CI 1.28-1.72; p < 0.001), major complications (OR 1.52, 95 % CI 1.31-1.77, p = 0.001), reoperation (OR 1.33, 95 % CI 1.04-1.69; p = 0.022), and extended length of stay > 1 day (OR 1.78, 95 % CI 1.41-2.25; p < 0.001) following a T +/- A. Conclusion: Higher ASA-PS classification is an independent predictor of complications following T +/- A. Surgeons should aim to optimize the systemic medical conditions of ASA-PS classes III and IV patients prior to T +/- A and implement post-operative management protocols specific to these patients to decrease morbidity, complications, and overall health care cost.

Automated summary

The study aimed to investigate the role of ASA-PS in predicting operative risk and complications following T +/- A. The results showed that higher ASA-PS classification is associated with increased risk of unplanned readmission, overall complications, major complications, reoperation, and extended length of stay.