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Table 2 Adult and Pediatric medical co-morbidities associated with different ASA PS assignment, step 2

From: Improving agreement of ASA physical status class between pre-anesthesia screening and day of surgery by adding institutional-specific and ASA-approved examples: a quality improvement project

 

Adult (n = 235)

ASA-example

 

Pediatric (n = 95)

ASA-example

BMI

16%

Y

URI (includes sinusitis, adenoiditis) or OM

21%

N

HTN

13%

Y

OSA

21%

N

OSA

6%

N

Developmental delay (motor or cognitive)

16%

N

Cancer

6%

N

PCA in premature infant

8%

Y

PVD

6%

N

Asthma

6%

N

Tobacco

5%

Y

Dental caries

6%

N

Advanced age

4%

N/A

Full term valued as ASA 2

4%

N

CAD

4%

Y

Psychiatric conditions (bipolar, anxiety d/o, depression, autism)

3%

N

COPD

4%

N

Allergic rhinitis

6%

N

Dysrhythmia (atrial fibrillation, SVT pacemaker, AICD)

4%

Y

Anemia

1%

N

ESRD

4%

Y

Congenital heart disease

1%

N

Multiple co-morbidities

4%

N/A

Imperforate anus

1%

N

DM

3%

Y

Laryngeal papilloma

1%

N

CKD

3%

N

Craniosynostosis

1%

N

Psychiatric (bipolar, anxiety disorder, depression, autism)

2%

N

Scoliosis

1%

N

Anemia

2%

N

 

GERD

2%

N

Pulmonary HTN

2%

N

CVA/TIA

2%

Y

Allergic rhinitis

.5%

N

Asthma

.5%

Y

Down

.5%

N

Recent URI

.5%

N

  1. In Step 2, medical co-morbidities were identified as being valued differently by PREOP and DOS. In 28% of adult patients, more than one co-morbidity was identified; hence, the total number of co-morbidities is higher than number of patients. In 21% of pediatric patients, more than one co-morbidity was identified; hence, the total number of co-morbidities is higher than number of patients. For medical co-morbidity that occurred more than 1%, institutional-specific examples were developed if the ASA-approved examples did not address it. No example was developed for advanced age or multiple medical co-morbidities since the department anesthesiologists did not have consensus on how these should be handled. Unlike adult patients’ co-morbidities, almost all pediatric co-morbidities are not included in the ASA-approved examples
  2. AICD automatic implantable cardiac defibrillator, ASA PS ASA physical status class, BMI body mass index, CAD coronary artery disease, CKD chronic kidney disease, COPD chronic obstructive pulmonary disease, CVA cerebrovascular accident, DM diabetes mellitus, ESRD end-stage renal disease, GERD gastroesophageal reflux disease, HTN hypertension, OSA obstructive sleep apnea, PCA post-conceptual age, PVD peripheral vascular disease, SVT supraventricular tachycardia, TIA transient ischemic attack, URI upper respiratory infection