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Aims <p>The aims were to assess whether American Society of Anesthesiologists (ASA) grade influenced improvement in joint-specific outcomes (JSO), health-related quality of life (HRQoL), length of stay (LOS), readmission, or mortality after knee (KA) or total hip arthroplasty (THA).</p> Methods <p>This retrospective study was conducted over a 6-year period and included 7644 KA and 7745 THA. Patient demographics, ASA grade, LOS, 30-day readmission and postoperative mortality were recorded from National electronic medical records. Preoperative and 1-year postoperative Oxford knee/hip scores (OKS/OHS), EQ-5D and EQ-VAS scores were obtained from a local arthroplasty register, which had postoperative data for 6272 KA and 6182 THA.</p> Results <p>For both KA and THA cohorts, increasing ASA grade was associated with female gender (<i>p</i> &lt; 0.001), older age (<i>p</i> &lt; 0.001), and worse preoperative Oxford (<i>p</i> &lt; 0.001), EQ-5D (<i>p</i> &lt; 0.001), and EQ-VAS (<i>p</i> &lt; 0.001)&#xa0;scores. Unadjusted improvements in OKS (<i>p</i> = 0.866), EQ-5D (<i>p</i> = 0.574) or EQ-VAS (<i>p</i> = 0.714) were not significantly influenced by ASA grade after KA. In contrast, those with a worse ASA grade had significantly (<i>p</i> &lt; 0.001) greater improvements in the OHS and EQ-5D. A higher ASA grade was associated with an increased risk of readmission (KA <i>p</i> = 0.020, THA <i>p</i> &lt; 0.001). When adjusting for confounding factors ASA grades 3 and 4 were associated with an increased risk of mortality relative to ASA 1 following KA and THA. ASA 3 (KA + 0.9&#xa0;days, <i>p</i> &lt; 0.001) and 4 (KA + 2.0&#xa0;days,<i> p</i> &lt; 0.001, THA + 3.0&#xa0;days <i>p</i> &lt; 0.001) were also independently associated with an increased length of stay relative to grade 1.</p> Conclusion <p>Increasing ASA grade did not have a clinically meaningful association with improvement in JSO or HRQoL following KA and THA, but was associated with an increased LOS, 30-day readmission and postoperative mortality risks.</p> Level of evidence <p>Retrospective study, Level III.</p>

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American society of anesthesiologists grade and association with joint specific outcome, health-related quality of life, readmission and mortality risk after hip and knee arthroplasty

  • 期刊论文

  • 发表日期：

    2025年8月14日

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  • Nick D. Clement,
  • Ali Ridha,
  • Adi Vijay,
  • Donia Karimaghaei,
  • Nagavaishnavi Bhaskara,
  • Irrum Afzal,
  • Deiary F. Kader

摘要

Aims

The aims were to assess whether American Society of Anesthesiologists (ASA) grade influenced improvement in joint-specific outcomes (JSO), health-related quality of life (HRQoL), length of stay (LOS), readmission, or mortality after knee (KA) or total hip arthroplasty (THA).

Methods

This retrospective study was conducted over a 6-year period and included 7644 KA and 7745 THA. Patient demographics, ASA grade, LOS, 30-day readmission and postoperative mortality were recorded from National electronic medical records. Preoperative and 1-year postoperative Oxford knee/hip scores (OKS/OHS), EQ-5D and EQ-VAS scores were obtained from a local arthroplasty register, which had postoperative data for 6272 KA and 6182 THA.

Results

For both KA and THA cohorts, increasing ASA grade was associated with female gender (p < 0.001), older age (p < 0.001), and worse preoperative Oxford (p < 0.001), EQ-5D (p < 0.001), and EQ-VAS (p < 0.001) scores. Unadjusted improvements in OKS (p = 0.866), EQ-5D (p = 0.574) or EQ-VAS (p = 0.714) were not significantly influenced by ASA grade after KA. In contrast, those with a worse ASA grade had significantly (p < 0.001) greater improvements in the OHS and EQ-5D. A higher ASA grade was associated with an increased risk of readmission (KA p = 0.020, THA p < 0.001). When adjusting for confounding factors ASA grades 3 and 4 were associated with an increased risk of mortality relative to ASA 1 following KA and THA. ASA 3 (KA + 0.9 days, p < 0.001) and 4 (KA + 2.0 days, p < 0.001, THA + 3.0 days p < 0.001) were also independently associated with an increased length of stay relative to grade 1.

Conclusion

Increasing ASA grade did not have a clinically meaningful association with improvement in JSO or HRQoL following KA and THA, but was associated with an increased LOS, 30-day readmission and postoperative mortality risks.

Level of evidence

Retrospective study, Level III.