COMPARISON OF 2 PREOPERATIVE INDEXES TO PREDICT PERIOPERATIVE MORTALITY IN NONCARDIAC THORACIC-SURGERY

Objective: The preoperative classifications: physical status of the am erican society of anesthesiologists (ASA-PS) and/or cardiac risk index (CRI) of Goldman are widely used to estimate the perioperative risk i n patients undergoing noncardiac thoracic surgery. We tried to determi ne the validity of both methods in predicting the perioperative mortal ity in 845 consecutive patients scheduled for major elective noncardia c thoracic surgery. Methods: Preoperatively, each patient was assigned 2 independent estimations of risk according to the ASA-score (ASA gra de, I-IV) and CRI score (CRI grade, I-IV), respectively. Results: Twen ty-five patients died within 4 weeks after the operation, the others s urvived the perioperative period. The grading according to ASA as well as to the CRI score showed a direct correlation with the outcome: The higher the preoperative score, the higher was the mortality rate. Whe n various combinations of ASA and CRI were tested: the lowest mortalit y rate was found in presence of ASA less than or equal to III and CRI = I. Multivariate regression analysis showed that the ASA score had an independent correlation with perioperative mortality, whereas such a relationship was absent for CRI. Conclusions: The subjective assessmen t by an experienced anesthesiologist as expressed by the ASA-score is a valid method in the determination of the perioperative risk. CRI doe s nor contribute additional information for the general perioperative risk. (C) 1997 Elsevier Science B.V.