![]() ![]() ![]() It was developed for statistical purposes and not as a surgical risk predictor. Its simplicity represents its greatest strength as well as a limitation in a world of comprehensive multisystem tools. Incorporating multimorbidity into the ASA classification might be warranted to improve its predictive ability and support adequate reimbursement. The American Society of Anesthesiologists (ASA) Physical Status classification system celebrates its 80th anniversary in 2021. Multimorbidity in perioperative patients is highly prevalent and has a relevant impact on hospital costs, independent of the ASA class. ASA Sailing Courses ASA 101, Basic Keelboat Sailing ASA 103, Basic Coastal Cruising ASA 104, Bareboat Chartering ASA 105, Coastal Navigation ASA 106. The number of anaesthesia-relevant comorbidities also increased postoperative complications and postoperative length of hospital stay. Independent of ASA class, each additional comorbidity increased hospital costs by EUR 1,198 (95% CI 288-2108) with almost identical proportions of direct and indirect effects. The median number of comorbidities per patient was 5 (range 0-18), this number significantly increasing with higher ASA class: 1 comorbidity (95% CI 0.0-2.0) in ASA I, 4 comorbidities (3.8-4.2) in ASA II, 9 (8.1-9.9) in ASA III and 12 (10-14) in ASA IV patients. Using structural equation models, the direct and indirect effects of comorbidities on costs were estimated after adjustment for the ASA class and further relevant confounders and mediators. The primary endpoint was the number of all anaesthesia-relevant comorbidities by ASA class. In addition, the type and severity of all perioperatively relevant comorbidities were extracted from the electronic medical record according to a predefined list. Approximately 30 patients per surgical discipline undergoing any type of in-hospital surgery were followed up until hospital discharge to record all intra- and postoperative adverse events. This cohort study is nested in the ClassIntra® validation study and includes only patients enrolled at the University Hospital of Basel. This study aimed to assess the number and type of all anaesthesia-relevant comorbidities and to analyse their impact on outcome and hospital costs. The American Society of Anesthesiologists (ASA) classification uses only the single most severe systemic disease to define the ASA class and ignores multimorbidity. Data on both the prevalence of multimorbidity and its impact on perioperative outcome are limited. Multimorbidity is a growing global health problem, resulting in an increased perioperative risk for surgical patients. ![]()
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