ASA Physical Status IV patients can be treated successfully on an outpatient basis, but they're twice as likely as healthier patients to need hospital admissions afterward, according to Anesthesiology News.
Researchers at the University of North Carolina at Chapel Hill School of Medicine looked at EHR records for 25,000 patients presenting for ambulatory surgery between July 2014 and June 2015. Approximately 6 percent were deemed ASA physical status IV.
Here are six findings.
1. Unplanned admissions occurred in approximately 7 percent of ASA IV ambulatory patients.
2. ASA IV patients were 2 to 2.7 times more likely to be unexpectedly admitted than ASA I, II or III patients.
3. ASA IV patients undergoing gastrointestinal, ENT, oral medicine, pediatric surgery, plastic surgery, trauma, women's primary gynecology, urology, transplantation and vascular services were more likely to be admitted.
4. ASA IV patients with a history of anxiety and depression were also more likely to be admitted.
5. "The message here is that performing ambulatory surgery on ASA IV patients is doable," said Caryn M. Hertz, MD, an associate professor of anesthesiology at the University of North Carolina at Chapel Hill School of Medicine. "They are clearly going to be admitted more often than their ASA I to III counterparts, but even at a 7 percent admission rate, it's very feasible."
6. ASCs should still exercise caution and only treat chronically stable ASA IV patients with the least invasive surgical procedures, according to Rosalind Ritchie-Dabney, MD, the medical director of the Lexington-based Center for Advanced Surgery at University of Kentucky HealthCare.
"I believe the University of North Carolina is a hospital-based ambulatory surgery center, which has many additional resources. However, such additional resources are limited or nonexistent for freestanding ambulatory surgery centers," she said.
