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Type: Journal article
Title: Self-reported fitness of American Society of Anesthesiologists class 3 patients undergoing endovascular aneurysm repair predicts patient survival
Author: Boult, M.
Howell, S.
Cowled, P.
De Loryn, T.
Fitridge, R.
Citation: Journal of Vascular Surgery, 2015; 62(2):299-303
Publisher: Elsevier
Issue Date: 2015
ISSN: 0741-5214
Statement of
Margaret Boult, Stuart Howell, Prue Cowled, Tania De Loryn, and Robert Fitridge
Abstract: BACKGROUND: Most patients undergoing elective endovascular aneurysm repair (EVAR) are classified American Society of Anesthesiologists (ASA) 3. However, the severity of systemic disease among these patients can vary, resulting in markedly different levels of fitness. In this study, we explored the hypothesis that ASA 3 patients with good self-reported exercise tolerance have better survival after EVAR. METHODS: Data for EVAR patients classified ASA 3 were extracted retrospectively from a prospectively collected registry database. Patients were split into two groups according to fitness level, based on their self-reported ability to climb stairs or to walk briskly for 1 km. Patient survival for each group was assessed by Cox proportional hazards models. RESULTS: During follow-up of 392 patients for a mean of 1.9 years, there were 64 deaths (16.3%), 13.4% in the more physically able group and 21.6% in the less able group. Self-reported inability to walk or to climb stairs was associated with increased risk of all-cause mortality (hazard ratio, 3.55; P < .0001). Following risk adjustment for a number of possible confounding variables, fitness remained significant (hazard ratio, 3.03; P = .0011). CONCLUSIONS: This study has shown that among ASA 3 patients, self-reported exercise capacity is an excellent means of predicting survival. Physicians should consider the physical fitness of their ASA 3 patients when discussing treatment options.
Keywords: Humans
Aortic Aneurysm, Abdominal
Treatment Outcome
Blood Vessel Prosthesis Implantation
Health Status Indicators
Survival Analysis
Retrospective Studies
Exercise Tolerance
Aged, 80 and over
Endovascular Procedures
Self Report
Elective Surgical Procedures
Description: A preliminary version of this study was presented as an oral communication at the Annual Scientific Meeting of the Australian and New Zealand Society for Vascular Surgery, Canberra, Australia, October 11-13, 2014.
Rights: Copyright © 2015 by the Society for Vascular Surgery
DOI: 10.1016/j.jvs.2015.03.022
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