The American Society of Anesthesiologists Physical Status Classification Versus Acute Physiology and Chronic Health Evaluation II for Predicting Perioperative Outcomes in Surgical Patients

Background Accurate perioperative risk stratification guides the management of surgical patients, yet evidence comparing common scoring systems in India is limited. This study aims to evaluate the American Society of Anesthesiologists Physical Status (ASA-PS) classification and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score for predicting perioperative risk, postoperative mortality, and intensive care unit (ICU) use. Methods In this prospective follow‑up study conducted at a tertiary care center in Northeast India, adults aged 18-75 years who underwent emergency or elective major surgery between June 2018 and May 2019 were enrolled. Investigators assigned ASA-PS grades and calculated APACHE II scores preoperatively. Receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) assessed each score's ability to predict ICU stay > 24 hours and 30‑day all‑cause mortality. Calibration was evaluated with the Hosmer-Lemeshow goodness‑of‑fit test. Results Among 152 patients (mean age = 44.7 ± 17 years; 54.6% men), preoperative APACHE II showed better discrimination for prolonged ICU admission (AUC = 0.804) than ASA‑PS (AUC = 0.627). An APACHE II threshold > 7 predicted ICU stay > 24 hours with 75% sensitivity and 74% specificity, whereas an ASA‑PS grade > 2 achieved 69% sensitivity and 50% specificity. For overall mortality, APACHE II and ASA‑PS showed similar performance (AUC = 0.708 vs. 0.737). An APACHE II score > 5 and an ASA‑PS grade > 2 each provided 86% sensitivity, with specificities of 47% and 52%, respectively. Both APACHE II and ASA‑PS showed good calibration (Hosmer-Lemeshow p > 0.05), indicating close agreement between observed and predicted mortality rates. Conclusions In surgical patients, the APACHE II score provides a more reliable prediction of perioperative risk and prolonged ICU stay than the ASA-PS classification, while both scores offer comparable, moderate accuracy for mortality. Incorporating objective scoring systems, such as APACHE II, into routine assessment may enhance perioperative decision-making and patient outcomes.