FREQUENCY OF MORTALITY WITH AMERICAN SOCIETY OF ANESTHESIOLOGISTPHYSICAL STATUS (ASA PS) CLASSIFICATION CLASS (I, II, III)AFTER NEUROSURGICAL PROCEDURES IN IGH PESHAWAR

Abstract

Background: The American Society of Anesthesiologists (ASA) Physical Status Classification System is commonly used to assess the preoperative physical condition of patients and estimate perioperative risk. In neurosurgical patients, accurate assessment of physical status is important because underlying systemic and neurological conditions may influence postoperative outcomes. Objective: To assess the association between ASA Physical Status classification and short-term postoperative mortality among patients undergoing neurosurgical procedures. Methods: A cross-sectional study was conducted in the Neurosurgical Department of Irfan General Hospital, Peshawar, from January to June 2018. A total of 178 adult patients of both sexes undergoing neurosurgical procedures and classified as ASA I, II, or III were included through non-probability convenient sampling. Patients were followed for 48–72 hours after surgery to assess postoperative outcomes. Data were analyzed using SPSS version 22. Frequencies and percentages were calculated for categorical variables, while mean and standard deviation were used for continuous variables. The association between ASA classification and postoperative outcome was assessed using correlation and statistical testing, with p≤0.05 considered significant. Results: Among 178 patients, 111 (62.4%) were male and 67 (37.6%) were female. The majority of patients were classified as ASA I (108, 60.7%), followed by ASA II (56, 31.5%) and ASA III (14, 7.9%). Craniotomy was the most frequently performed procedure (104, 58.4%), followed by laminectomy (34, 19.1%) and discectomy (18, 10.1%). Overall, 146 (82.0%) patients were discharged and 32 (18.0%) died within 48–72 hours after surgery. Mortality increased with higher ASA classification: 10.2% in ASA I, 19.6% in ASA II, and 71.4% in ASA III. A significant positive correlation was observed between ASA classification and postoperative outcome (r=0.365, p<0.001). Mortality was also higher among patients aged over 60 years.

Conclusion: Higher ASA Physical Status classification was associated with increased short-term mortality among neurosurgical patients. ASA III patients demonstrated the highest mortality, indicating that preoperative physical status assessment may help identify patients at greater risk and support appropriate perioperative planning and postoperative monitoring.