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A Meta-analysis of the Predictive Accuracy of Postoperative Mortality Using the American Society of Anesthesiologists’ Physical Status Classification System

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Abstract

Background

The American Society of Anesthesiologists’ physical status (ASA) tool has been applied to determine compensation, risk adjustment and risk prediction, but little is known about the accuracy and generalizability of this tool for prediction of postoperative mortality.

Methods

We systematically investigated prior published reports of associations between ASA physical status and mortality to test the hypothesis that ASA physical status will have varying accuracy in prediction of postoperative mortality across surgical populations with varying surgical risk of mortality. We used random effects models and metaregression to account for heterogeneity.

Results

Combining 77 studies with 165,705 patients, the ASA physical status tool demonstrated the following pooled performance (95 % confidence intervals)—sensitivity 0.74 (0.73, 0.74), specificity 0.67 (0.67, 0.67), and area under summary receiver operating curve 0.736 (0.725, 0.747). Metaregression revealed that study death rates and surgical specialty were significant factors.

Conclusion

ASA physical status is a better predictor of postoperative mortality in settings with lower rather than higher death rates.

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Notes

  1. * UBC Bayesian Calculator. Available at http://spph.ubc.ca/sites/healthcare/files/calc/bayes.html Accessed March 20, 2013.

References

  1. Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372:139–144

    Article  PubMed  Google Scholar 

  2. Gawande AA, Thomas EJ, Zinner MJ, Brennan TA (1999) The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery 126:66–75

    Article  CAS  PubMed  Google Scholar 

  3. Kable AK, Gibberd RW, Spigelman AD (2002) Adverse events in surgical patients in Australia. Int J Qual Health Care 14:269–276

    Article  CAS  PubMed  Google Scholar 

  4. Davenport DL, Bowe EA, Henderson WG, Khuri SF, Mentzer RM Jr (2006) National Surgical Quality Improvement Program (NSQIP) risk factors can be used to validate American Society of Anesthesiologists Physical Status Classification (ASA PS) levels. Ann Surg 243:636–641 discussion 641-634

    Article  PubMed Central  PubMed  Google Scholar 

  5. Owens WD (2001) American Society of Anesthesiologists physical status classification system in not a risk classification system. Anesthesiology 94:378

    Article  CAS  PubMed  Google Scholar 

  6. Fischer SP, Bader AM, Sweitzer B (2010) Preoperative evaluation. In: Miller RD (ed) Miller’s anesthesia, 7th edn. Churchill Livingstone Elsevier, Philadelphia, p 1002

    Google Scholar 

  7. Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A (2006) Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 6:31

    Article  PubMed Central  PubMed  Google Scholar 

  8. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed Central  PubMed  Google Scholar 

  9. Lijmer JG, Bossuyt PM, Heisterkamp SH (2002) Exploring sources of heterogeneity in systematic reviews of diagnostic tests. Stat Med 21:1525–1537

    Article  PubMed  Google Scholar 

  10. Ackland GL, Harris S, Ziabari Y, Grocott M, Mythen M (2010) Revised cardiac risk index and postoperative morbidity after elective orthopaedic surgery: a prospective cohort study. Br J Anaesth 105:744–752

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Ford MK, Beattie WS, Wijeysundera DN (2010) Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index. Ann Intern Med 152:26–35

    Article  PubMed  Google Scholar 

  12. Bowles TA, Sanders KM, Colson M, Watters DA (2008) Simplified risk stratification in elective colorectal surgery. ANZ J Surg 78:24–27

    Article  PubMed  Google Scholar 

  13. Donati A, Ruzzi M, Adrario E, Pelaia P, Coluzzi F, Gabbanelli V et al (2004) A new and feasible model for predicting operative risk. Br J Anaesth 93:393–399

    Article  CAS  PubMed  Google Scholar 

  14. Garcea G, Ganga R, Neal CP, Ong SL, Dennison AR, Berry DP (2010) Preoperative early warning scores can predict in-hospital mortality and critical care admission following emergency surgery. J Surg Res 159:729–734

    Article  PubMed  Google Scholar 

  15. Young A, Ramachandran SK (2013) Clinical prediction of postoperative respiratory failure. Anesthesiology 118:1247–1249

    Article  PubMed  Google Scholar 

  16. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  17. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF et al (1999) Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 100:1043–1049

    Article  CAS  PubMed  Google Scholar 

  18. Zimmerman JE, Kramer AA, McNair DS, Malila FM (2006) Acute Physiology and Chronic Health Evaluation (APACHE) IV: hospital mortality assessment for today’s critically ill patients. Crit Care Med 34:1297–1310

    Article  PubMed  Google Scholar 

  19. Copeland GP, Jones D, Walters M (1991) POSSUM: a scoring system for surgical audit. Br J Surg 78:355–360

    Article  CAS  PubMed  Google Scholar 

  20. Grocott MP, Pearse RM (2010) Prognostic studies of perioperative risk: robust methodology is needed. Br J Anaesth 105:243–245

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Leeflang MM, Bossuyt PM, Irwig L (2009) Diagnostic test accuracy may vary with prevalence: implications for evidence-based diagnosis. J Clin Epidemiol 62:5–12

    Article  PubMed  Google Scholar 

  22. Moons KG, van Es GA, Deckers JW, Habbema JD, Grobbee DE (1997) Limitations of sensitivity, specificity, likelihood ratio, and bayes’ theorem in assessing diagnostic probabilities: a clinical example. Epidemiology 8:12–17

    Article  CAS  PubMed  Google Scholar 

  23. Brueckmann B, Villa-Uribe JL, Bateman BT, Grosse-Sundrup M, Hess DR, Schlett CL, Eikermann M (2013) Development and validation of a score for prediction of postoperative respiratory complications. Anesthesiology 118:1276–1285

    Article  PubMed  Google Scholar 

  24. Dalton JE, Kurz A, Turan A, Mascha EJ, Sessler DI, Saager L (2011) Development and validation of a risk quantification index for 30-day postoperative mortality and morbidity in noncardiac surgical patients. Anesthesiology 114:1336–1344

    Article  PubMed  Google Scholar 

  25. Mulherin SA, Miller WC (2002) Spectrum bias or spectrum effect? Subgroup variation in diagnostic test evaluation. Ann Intern Med 137:598–602

    Article  PubMed  Google Scholar 

  26. Ransohoff DF, Feinstein AR (1978) Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med 299:926–930

    Article  CAS  PubMed  Google Scholar 

  27. Froehner M, Koch R, Litz R, Heller A, Oehlschlaeger S, Wirth MP (2003) Comparison of the American Society of Anesthesiologists physical status classification with the Charlson score as predictors of survival after radical prostatectomy. Urology 62:698–701

    Article  PubMed  Google Scholar 

  28. Prause G, Offner A, Ratzenhofer-Komenda B, Vicenzi M, Smolle J, Smolle-Juttner F (1997) Comparison of two preoperative indices to predict perioperative mortality in non-cardiac thoracic surgery. Eur J Cardiothorac Surg 11:670–675

    Article  CAS  PubMed  Google Scholar 

  29. Mekel M, Stephen AE, Gaz RD, Perry ZH, Hodin RA, Parangi S (2009) Thyroid surgery in octogenarians is associated with higher complication rates. Surgery 146:913–921

    Article  PubMed  Google Scholar 

  30. Rohrig R, Junger A, Hartmann B, Klasen J, Quinzio L, Jost A et al (2004) The incidence and prediction of automatically detected intraoperative cardiovascular events in noncardiac surgery. Anesth Analg 98:569–577 table of contents

    Article  PubMed  Google Scholar 

  31. Parmar CD, Torella F (2010) Prediction of major adverse cardiac events in vascular surgery: are cardiac risk scores of any practical value? Vasc Endovasc Surg 44:14–19

    Article  Google Scholar 

  32. Barnes M, Boult M, Maddern G, Fitridge R (2008) A model to predict outcomes for endovascular aneurysm repair using preoperative variables. Eur J Vasc Endovasc Surg 35:571–579

    Article  CAS  PubMed  Google Scholar 

  33. Kwok AC, Lipsitz SR, Bader AM, Gawande AA (2011) Are targeted preoperative risk prediction tools more powerful? A test of models for emergency colon surgery in the very elderly. J Am Coll Surg 213:220–225

    Article  PubMed  Google Scholar 

  34. Robinson TN, Eiseman B, Wallace JI, Church SD, McFann KK, Pfister SM et al (2009) Redefining geriatric preoperative assessment using frailty, disability and co-morbidity. Ann Surg 250:449–455

    PubMed  Google Scholar 

  35. Saxton A, Velanovich V (2011) Preoperative frailty and quality of life as predictors of postoperative complications. Ann Surg 253:1223–1229

    Article  PubMed  Google Scholar 

  36. Curtin F, Morabia A, Pichard C, Slosman DO (1997) Body mass index compared to dual-energy x-ray absorptiometry: evidence for a spectrum bias. J Clin Epidemiol 50:837–843

    Article  CAS  PubMed  Google Scholar 

  37. Hlatky MA, Pryor DB, Harrell FE Jr, Califf RM, Mark DB, Rosati RA (1984) Factors affecting sensitivity and specificity of exercise electrocardiography. Multivariable analysis. Am J Med 77:64–71

    Article  CAS  PubMed  Google Scholar 

  38. Haynes SR, Lawler PG (1995) An assessment of the consistency of ASA physical status classification allocation. Anaesthesia 50:195–199

    Article  CAS  PubMed  Google Scholar 

  39. Aronson WL, McAuliffe MS, Miller K (2003) Variability in the American Society of Anesthesiologists physical status classification scale. AANA J 71:265–274

    PubMed  Google Scholar 

  40. Mak PH, Campbell RC, Irwin MG (2002) The ASA Physical Status Classification: inter-observer consistency. American Society of Anesthesiologists. Anaesth Intensiv Care 30:633–640

    CAS  Google Scholar 

  41. Saklad M (1941) Grading of patients for surgical procedures. Anesthesiology 2:281–284

    Article  Google Scholar 

  42. Alvarez JA, Baldonedo RF, Bear IG, Truan N, Pire G, Alvarez P (2005) Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg 190:376–382

    Article  PubMed  Google Scholar 

  43. Antolovic D, Koch M, Hinz U, Schottler D, Schmidt T, Heger U et al (2008) Ischemic colitis: analysis of risk factors for postoperative mortality. Langenbecks Arch Surg 393:507–512

    Article  PubMed  Google Scholar 

  44. Arenal JJ, Bengoechea-Beeby M (2003) Mortality associated with emergency abdominal surgery in the elderly. Can J Surg 46:111–116

    PubMed Central  PubMed  Google Scholar 

  45. Arenal JJ, Tinoco C, Labarga F, Martinez R, Gonzalo M (2012) Colorectal cancer in nonagenarians. Colorectal Dis 14:44–47

    Article  CAS  PubMed  Google Scholar 

  46. Arenal-Vera JJ, Tinoco-Carrasco C, del-Villar-Negro A, Labarga-Rodriguez F, Delgado-Mucientes A, Citores MA (2011) Colorectal cancer in the elderly: characteristics and short term results. Rev Esp Enferm Dig 103:408–415

    Article  PubMed  Google Scholar 

  47. Awad S, Herrod PJ, Palmer R, Carty HM, Abercrombie JF, Brooks A et al (2012) One- and two-year outcomes and predictors of mortality following emergency laparotomy: a consecutive series from a United Kingdom teaching hospital. World J Surg 36:2060–2067. doi:10.1007/s00268-012-1614-0

    Article  PubMed  Google Scholar 

  48. Berod AA, Colin P, Yates DR, Ouzzane A, Audouin M, Adam E et al (2012) The role of American Society of Anesthesiologists scores in predicting urothelial carcinoma of the upper urinary tract outcome after radical nephroureterectomy: results from a national multi-institutional collaborative study. BJU Int 110:E1035–E1040

    Article  PubMed  Google Scholar 

  49. Bharti N, Batra YK, Kaur H (2009) Paediatric perioperative cardiac arrest and its mortality: database of a 60-month period from a tertiary care paediatric centre. Eur J Anaesthesiol 26:490–495

    Article  PubMed  Google Scholar 

  50. Biondo S, Ramos E, Deiros M, Rague JM, De Oca J, Moreno P et al (2000) Prognostic factors for mortality in left colonic peritonitis: a new scoring system. J Am Coll Surg 191:635–642

    Article  CAS  PubMed  Google Scholar 

  51. Bjorkelund KB, Hommel A, Thorngren KG, Lundberg D, Larsson S (2009) Factors at admission associated with 4 months outcome in elderly patients with hip fracture. AANA J 77:49–58

    PubMed  Google Scholar 

  52. Bostrom PJ, Kossi J, Laato M, Nurmi M (2009) Risk factors for mortality and morbidity related to radical cystectomy. BJU Int 103:191–196

    Article  PubMed  Google Scholar 

  53. Campbell WB, Marriott S, Eve R, Mapson E, Sexton S, Thompson JF (2001) Factors influencing the early outcome of major lower limb amputation for vascular disease. Ann R Coll Surg Engl 83:309–314

    CAS  PubMed Central  PubMed  Google Scholar 

  54. Clarke MG, Bunting D, Smart NJ, Lowes J, Mitchell SJ (2010) The surgical management of acute upper gastrointestinal bleeding: a 12-year experience. Int J Surg 8:377–380

    Article  CAS  PubMed  Google Scholar 

  55. Cook TM, Day CJ (1998) Hospital mortality after urgent and emergency laparotomy in patients aged 65 yr and over. Risk and prediction of risk using multiple logistic regression analysis. Br J Anaesth 80:776–781

    Article  CAS  PubMed  Google Scholar 

  56. Cuypers P, Nevelsteen A, Buth J, Hamming J, Stockx L, Lacroix H et al (1999) Complications in the endovascular repair of abdominal aortic aneurysms: a risk factor analysis. Eur J Vasc Endovasc Surg 18:245–252

    Article  CAS  PubMed  Google Scholar 

  57. Delis SG, Bakoyiannis A, Biliatis I, Athanassiou K, Tassopoulos N, Dervenis C (2009) Model for end-stage liver disease (MELD) score, as a prognostic factor for post-operative morbidity and mortality in cirrhotic patients, undergoing hepatectomy for hepatocellular carcinoma. HPB (Oxford) 11:351–357

    Article  Google Scholar 

  58. Duckworth AD, Phillips SA, Stone O, Moran M, Breusch SJ, Biant LC (2012) Deep infection after hip fracture surgery: predictors of early mortality. Injury 43:1182–1186

    Article  PubMed  Google Scholar 

  59. Duron JJ, Duron E, Dugue T, Pujol J, Muscari F, Collet D et al (2011) Risk factors for mortality in major digestive surgery in the elderly: a multicenter prospective study. Ann Surg 254:375–382

    Article  PubMed  Google Scholar 

  60. Eeson G, Chang N, McGahan CE, Khurshed F, Buczkowski AK, Scudamore CH et al (2012) Determination of factors predictive of outcome for patients undergoing a pancreaticoduodenectomy of pancreatic head ductal adenocarcinomas. HPB (Oxford) 14:310–316

    Article  Google Scholar 

  61. Fazio VW, Tekkis PP, Remzi F, Lavery IC (2004) Assessment of operative risk in colorectal cancer surgery: the Cleveland Clinic Foundation colorectal cancer model. Dis Colon Rectum 47:2015–2024

    Article  PubMed  Google Scholar 

  62. Fu KM, Smith JS, Polly DW Jr, Ames CP, Berven SH, Perra JH et al (2011) Correlation of higher preoperative American Society of Anesthesiology grade and increased morbidity and mortality rates in patients undergoing spine surgery. J Neurosurg Spine 14:470–474

    Article  PubMed  Google Scholar 

  63. Gaston MS, Amin AK, Clayton RA, Brenkel IJ (2007) Does a history of cardiac disease or hypertension increase mortality following primary elective total hip arthroplasty? Surgeon 5:260–265

    Article  CAS  PubMed  Google Scholar 

  64. Groenendijk RP, Croiset van Uchelen FA, Mol SJ, de Munck DR, Tan AT, Roumen RM (1999) Factors related to outcome after pneumonectomy: retrospective study of 62 patients. Eur J Surg 165:193–197

    Article  CAS  PubMed  Google Scholar 

  65. Hartwig W, Hackert T, Hinz U, Gluth A, Bergmann F, Strobel O et al (2011) Pancreatic cancer surgery in the new millennium: better prediction of outcome. Ann Surg 254:311–319

    Article  PubMed  Google Scholar 

  66. Hennein HA, Mendeloff EN, Cilley RE, Bove EL, Coran AG (1994) Predictors of postoperative outcome after general surgical procedures in patients with congenital heart disease. J Pediatr Surg 29:866–870

    Article  CAS  PubMed  Google Scholar 

  67. Holt G, Smith R, Duncan K, Finlayson DF, Gregori A (2008) Early mortality after surgical fixation of hip fractures in the elderly: an analysis of data from the scottish hip fracture audit. J Bone Joint Surg Br 90:1357–1363

    Article  CAS  PubMed  Google Scholar 

  68. Holvik K, Ranhoff AH, Martinsen MI, Solheim LF (2010) Predictors of mortality in older hip fracture inpatients admitted to an orthogeriatric unit in oslo, norway. J Aging Health 22:1114–1131

    Article  PubMed  Google Scholar 

  69. Kang N, Cole T, Tsang V, Elliott M, de Leval M (2004) Risk stratification in paediatric open-heart surgery. Eur J Cardiothorac Surg 26:3–11

    Article  PubMed  Google Scholar 

  70. Klima DA, Brintzenhoff RA, Agee N, Walters A, Heniford BT, Mostafa G (2012) A review of factors that affect mortality following colectomy. J Surg Res 174:192–199

    Article  PubMed  Google Scholar 

  71. Kocer B, Surmeli S, Solak C, Unal B, Bozkurt B, Yildirim O et al (2007) Factors affecting mortality and morbidity in patients with peptic ulcer perforation. J Gastroenterol Hepatol 22:565–570

    Article  PubMed  Google Scholar 

  72. Koksoy FN, Gonullu D, Catal O, Kuroglu E (2010) Risk factors for operative mortality and morbidity in gastric cancer undergoing D2-gastrectomy. Int J Surg 8:633–635

    Article  PubMed  Google Scholar 

  73. Kurup HV, Mehta RL (2006) The male neck of femur. Arch Orthop Trauma Surg 126:181–183

    Article  CAS  PubMed  Google Scholar 

  74. Larusson HJ, Zingg U, Hahnloser D, Delport K, Seifert B, Oertli D (2009) Predictive factors for morbidity and mortality in patients undergoing laparoscopic paraesophageal hernia repair: age, ASA score and operation type influence morbidity. World J Surg 33:980–985. doi:10.1007/s00268-009-9958-9

    Article  PubMed  Google Scholar 

  75. Limmer S, Hauenschild L, Eckmann C, Czymek R, Schmidt H, Bruch HP et al (2009) Thoracic surgery in the elderly–co-morbidity is the limit. Interact CardioVasc Thorac Surg 8:412–416

    Article  PubMed  Google Scholar 

  76. Limmer S, Unger L, Czymek R, Kujath P, Hoffmann M (2011) Emergency thoracic surgery in elderly patients. JRSM Short Rep 2:13

    Article  PubMed Central  PubMed  Google Scholar 

  77. Lindholm ML, Traff S, Granath F, Greenwald SD, Ekbom A, Lennmarken C et al (2009) Mortality within 2 years after surgery in relation to low intraoperative bispectral index values and preexisting malignant disease. Anesth Analg 108:508–512

    Article  PubMed  Google Scholar 

  78. Makela JT, Kiviniemi H, Laitinen S (2005) Prognostic factors of perforated sigmoid diverticulitis in the elderly. Dig Surg 22:100–106

    Article  PubMed  Google Scholar 

  79. Makela JT, Kiviniemi H, Ohtonen P, Laitinen SO (2002) Factors that predict morbidity and mortality in patients with perforated peptic ulcers. Eur J Surg 168:446–451

    Article  PubMed  Google Scholar 

  80. Marrelli D, Pedrazzani C, Neri A, Corso G, DeStefano A, Pinto E et al (2007) Complications after extended (D2) and superextended (D3) lymphadenectomy for gastric cancer: analysis of potential risk factors. Ann Surg Oncol 14:25–33

    Article  PubMed  Google Scholar 

  81. Martinez JL, Luque-de-Leon E, Andrade P (2008) Factors related to anastomotic dehiscence and mortality after terminal stomal closure in the management of patients with severe secondary peritonitis. J Gastrointest Surg 12:2110–2118

    Article  PubMed  Google Scholar 

  82. Mayr R, May M, Martini T, Lodde M, Comploj E, Pycha A et al (2012) Comorbidity and performance indices as predictors of cancer-independent mortality but not of cancer-specific mortality after radical cystectomy for urothelial carcinoma of the bladder. Eur Urol 62:662–670

    Article  PubMed  Google Scholar 

  83. McCulloch P, Ward J, Tekkis PP (2003) Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study. BMJ 327:1192–1197

    Article  PubMed Central  PubMed  Google Scholar 

  84. Muller MW, Friess H, Koninger J, Martin D, Wente MN, Hinz U et al (2008) Factors influencing survival after bypass procedures in patients with advanced pancreatic adenocarcinomas. Am J Surg 195:221–228

    Article  PubMed  Google Scholar 

  85. Neeff H, Mariaskin D, Spangenberg HC, Hopt UT, Makowiec F (2011) Perioperative mortality after non-hepatic general surgery in patients with liver cirrhosis: an analysis of 138 operations in the 2000s using Child and MELD scores. J Gastrointest Surg 15:1–11

    Article  PubMed  Google Scholar 

  86. Pateder DB, Gonzales RA, Kebaish KM, Cohen DB, Chang JY, Kostuik JP (2008) Short-term mortality and its association with independent risk factors in adult spinal deformity surgery. Spine (Phila Pa 1976) 33:1224–1228

  87. Rabadan AT, Hernandez D, Eleta M, Pietrani M, Baccanelli M, Christiansen S et al (2007) Factors related to surgical complications and their impact on the functional status in 236 open surgeries for malignant tumors in a Latino-American hospital. Surg Neurol 68:412–420 discussion 420

    Article  PubMed  Google Scholar 

  88. Rae HC, Harris IA, McEvoy L, Todorova T (2007) Delay to surgery and mortality after hip fracture. ANZ J Surg 77:889–891

    Article  PubMed  Google Scholar 

  89. Sauvanet A, Mariette C, Thomas P, Lozac’h P, Segol P, Tiret E et al (2005) Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors. J Am Coll Surg 201:253–262

    Article  PubMed  Google Scholar 

  90. Schul DB, Wolf S, Krammer MJ, Landscheidt JF, Tomasino A, Lumenta CB (2012) Meningioma surgery in the elderly: outcome and validation of 2 proposed grading score systems. Neurosurgery 70:555–565

    Article  PubMed  Google Scholar 

  91. Singh JA, Sperling JW, Cofield RH (2011) Ninety day mortality and its predictors after primary shoulder arthroplasty: an analysis of 4,019 patients from 1976-2008. BMC Musculoskelet Disord 12:231

    Article  PubMed Central  PubMed  Google Scholar 

  92. Skala K, Gervaz P, Buchs N, Inan I, Secic M, Mugnier-Konrad B et al (2009) Risk factors for mortality-morbidity after emergency-urgent colorectal surgery. Int J Colorectal Dis 24:311–316

    Article  CAS  PubMed  Google Scholar 

  93. Smith JS, Saulle D, Chen CJ, Lenke LG, Polly DW, Jr., Kasliwal MK, et al. (2012) Rates and causes of mortality associated with spine surgery based on 108,419 procedures: a review of the Scoliosis Research Society morbidity and mortality database. Spine (Phila Pa 1976) 37:1975–1982

  94. Soderqvist A, Ekstrom W, Ponzer S, Pettersson H, Cederholm T, Dalen N et al (2009) Prediction of mortality in elderly patients with hip fractures: a two-year prospective study of 1,944 patients. Gerontology 55:496–504

    Article  PubMed  Google Scholar 

  95. Talsnes O, Hjelmstedt F, Dahl OE, Pripp AH, Reikeras O (2011) Clinical and biochemical prediction of early fatal outcome following hip fracture in the elderly. Int Orthop 35:903–907

    Article  PubMed Central  PubMed  Google Scholar 

  96. Teh SH, Christein J, Donohue J, Que F, Kendrick M, Farnell M et al (2005) Hepatic resection of hepatocellular carcinoma in patients with cirrhosis: model of end-stage liver disease (MELD) score predicts perioperative mortality. J Gastrointest Surg 9:1207–1215 discussion 1215

    Article  PubMed  Google Scholar 

  97. Tekkis PP, Kinsman R, Thompson MR, Stamatakis JD (2004) The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg 240:76–81

    Article  PubMed Central  PubMed  Google Scholar 

  98. Tekkis PP, Poloniecki JD, Thompson MR, Stamatakis JD, Britain ACG (2003) Operative mortality in colorectal cancer: prospective national study. Br Med J 327:1196–1199

    Article  Google Scholar 

  99. Verbeek DO, Ponsen KJ, Goslings JC, Heetveld MJ (2008) Effect of surgical delay on outcome in hip fracture patients: a retrospective multivariate analysis of 192 patients. Int Orthop 32:13–18

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  100. Wisniowski B, Barnes M, Jenkins J, Boyne N, Kruger A, Walker PJ (2011) Predictors of outcome after elective endovascular abdominal aortic aneurysm repair and external validation of a risk prediction model. J Vasc Surg 54:644–653

    Article  PubMed  Google Scholar 

  101. Zini L, Patard JJ, Capitanio U, Crepel M, de La Taille A, Tostain J et al (2009) Cancer-specific and non-cancer-related mortality rates in European patients with T1a and T1b renal cell carcinoma. BJU Int 103:894–898

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Dr. Anoop Rao for his contributions toward study data collection.

Conflict of interest

C.Y.K., J.A.H, J.P.W., and M.E. do not report any conflicts of interest. S.K.R. has worked as an ad-hoc paid consultant on the scientific advisory board of Galleon Pharmaceuticals, Horsham, PA, USA and Merck, Sharpe and Dohme in 2013. SKR has active research funding from Merck, Sharpe and Dohme in 2014.This funding is unrelated to this study. J.P.W. is funded, in part, by the Foundation for Anesthesia Education and Research (FAER) through a Health Services Research Mentored Research Training Grant.

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Authors and Affiliations

  1. University Medicine Cluster, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore

    Chieh Yang Koo

  2. Department of Anesthesiology, Massachusetts General Hospital, Gray-Bigelow 444, 55 Fruit Street, Boston, MA, 02114, USA

    Joseph A. Hyder

  3. Department of Anesthesiology, Vanderbilt University, 1211, Medical Center Drive, Nashville, TN, 37232, USA

    Jonathan P. Wanderer

  4. Department of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Gray-Bigelow 444, 55 Fruit Street, Boston, MA, 02114, USA

    Matthias Eikermann

  5. Universitaetsklinikum Essen, Essen, Germany

    Matthias Eikermann

  6. Department of Anesthesiology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-0048, USA

    Satya Krishna Ramachandran

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  1. Chieh Yang Koo
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  2. Joseph A. Hyder
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  5. Satya Krishna Ramachandran
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Correspondence to Matthias Eikermann.

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Koo, C.Y., Hyder, J.A., Wanderer, J.P. et al. A Meta-analysis of the Predictive Accuracy of Postoperative Mortality Using the American Society of Anesthesiologists’ Physical Status Classification System. World J Surg 39, 88–103 (2015). https://doi.org/10.1007/s00268-014-2783-9

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