347 American Society of Anesthesiologists Physical Status Classification System Predicting Outcomes Following Nerve Transfer Surgery: A Nationwide Analysis

INTRODUCTION: The American Society of Anesthesiologists (ASA) physical status classification system serves as a valuable tool in preoperative risk assessment. However, its role in predicting postoperative outcomes following nerve transfer surgery remains understudied. METHODS: The 2007-2021 from the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset was employed to ascertain patients who underwent nerve transfer surgery. ASA classification was dichotomized into two cohorts:ASA<3 and ASA=3. Univariate analysis was conducted to examine the correlation between ASA classification and LOS, as well as postoperative complications. Multivariate logistic regression was employed to evaluate the independent impact of ASA classification on postoperative outcomes while controlling for baseline clinical characteristics. RESULTS: A total of 3209 patients were included in our analysis (43.1% female, mean age 46.5±16.7 years). On t test, ASA class=3 was associated with longer LOS (3.3 vs 1.5 days, p<0.001) compared to ASA<3. Patients with higher ASA class experienced a significantly increased risks of deep surgical site infection, wound dehiscence, unplanned reoperation, pneumonia, unplanned intubation, postoperative ventilator use, progressive renal insufficiency, urinary tract infection, stroke, myocardial infarction, bleeding requiring transfusion. On univariate analysis, ASA=3 was associated with higher risk of overall complications (OR 2.9 CI: 2.5 - 3.4, p<0.001). On multivariate logistic regression controlling for age, BMI, smoking, preoperative transfusion, disseminated cancer, chronic steroid use, modified 5-item frailty index, ASA=3 was an independent predictor of postoperative complications (OR 2.5 CI: 2.0-3.0, p<0.001). CONCLUSIONS: The ASA physical status classification system serves as a prognostic tool predicting hospital LOSs and postoperative outcomes following nerve transfer surgery. Implementation of preoperative risk stratification based on ASA classification may aid in optimizing perioperative care and improving patient outcomes in this surgical population.