Screening tool for tummy tuck patients
The simple and universally applicable American Society of Anesthesiologists classification system was successfully used to predict significant complications prior to abdominal contouring and can potentially rapidly screen patients for the procedure, according to a study in the December issue of Plastic and Reconstructive Surgery.
The primary outcome was any complication within 30 days of surgery.
“The physical status classification system is a system for assessing the fitness of patients before surgery,” co-author Teresa Benacquista, M.D., tells Cosmetic Surgery Times.
In 1963, the American Society of Anesthesiologists (ASA) adopted the five-category classification system: a healthy person; mild systemic disease; severe systemic disease; severe systemic disease that is a constant threat to life; and a moribund patient that is not expected to survive without an operation.
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The investigators used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2007 to 2012 to identify and stratify by classification a total of 3,637 patients undergoing abdominal contouring procedures.
The study found that the overall complication rate among study patients was 12%, and for mortality 0.2%.
Patients with a higher classification were more likely to have a complication. This trend was consistent for minor wound complications, medical complications and major surgical complications.
“As shown in our paper, the ASA classification system can help provide a more accurate risk assessment for patients undergoing abdominoplasty procedures,” says Dr. Benacquista, an associate professor of plastic surgery at Albert Einstein College of Medicine in Bronx, N.Y.
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“Complications will be decreased if a procedure is not carried out because the patient and/or surgeon decide that the associated risks are more than they are willing to undertake, due to the ASA classification of the patient,” Dr. Benacquista says.
However, outcomes may be improved “if there is concerted effort or a medical intervention prior to the surgery to improve the patient's ASA classification,” Dr. Benacquista says.
In the future, an informed patient consent prior to an abdominoplasty may include a discussion of the patient’s ASA classification “to allow the patient to have hard data about complications associated with their procedure,” Dr. Benacquista says.