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David Sola-Del Valle, Luis Alonso Gonzalez, Tulay Cakiner-Egilmez, Amy Chomsky, Elizabeth Baze, David Vollman, Mary Gilbert Lawrence, Mary K Daly; Association of American Society of Anesthesiology (ASA) Classification with Complications and Visual Outcomes of Cataract Surgery in the Veteran Population. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1571.
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© ARVO (1962-2015); The Authors (2016-present)
To determine whether the American Society of Anesthesiology (ASA) classification is associated with complications and visual outcomes of cataract surgery in the veteran population.
4,880 of 4,923 cataract surgery cases were included from the Ophthalmic Surgical Outcomes Data Project (OSOD), a multi-center retrospective cohort study from five Veterans Administration Medical Centers. Outcomes included BCVA, minor and major complications as well as intraoperative events. Fisher’s exact, Chi square, and McNemar’s tests were used in the statistical analysis. A longitudinal data analysis using multivariate logistic regression for the main outcome, and multivariable logistic regression models for secondary outcomes were performed adjusting for potential confounders.
By ASA criteria, there were 14 patients in class 1 (0.3%), 857 in class 2 (17.6%), 3,685 in class 3 (75.5%), and 324 in class 4 (6.6%). There was a significant difference in mean age in ASA categories 3 and 4 versus those in ASA categories 1 and 2 (71.5± 0.16 and 71.9±0.5 vs 60.2±2.5 and 66.4±0.3, p<0.0001). There was a higher percentage of small pupils in higher ASA classes (p<0.0001), a higher proportion of ocular trauma in lower ASA classes (p<0.003), and a higher proportion of diabetes mellitus, hypertension, smoking status and alcohol intake with higher ASA class (p<0.0001). The proportion of eyes with final postoperative BCVA better than 20/40 decreased as ASA class increased (p<0.003). All ASA class 1 patients with pre-operative BCVA worse than 20/40 significantly improved to better than or equal to 20/40, 91.2% in class 2, 91.2% in class 3, and 84.9% in class 4 did so (p=not estimable, p<0.0001, p<0.0001, p<0.0001). After adjusting for confounders, we found a significant association between ASA class and BCVA, with higher proportion of eyes improved as class decreases. There were no significant associations between ASA class and intraoperative events, major, or minor complications after adjustment for covariates.
Our study shows that as ASA class increases, the percentage of eyes that improve in BCVA decreases. However, this trend may be confounded by the higher prevalence of co-morbidities such as diabetes mellitus and hypertension. The association with final postoperative BCVA remained significant after adjusting for potential confounders.
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