Comparison of two preoperative indices to predict perioperative mortality in non-cardiac thoracic surgery

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Abstract
OBJECTIVE: The preoperative classifications: physical status of theAmerican Society of Anesthesiologists (ASA-PS) and/or cardiac risk index(CRI) of Goldman are widely used to estimate the perioperative risk inpatients undergoing noncardiac throacic surgery. We tried to determine thevalidity of both methods in predicting the perioperative mortality in 845consecutive patients scheduled for major elective noncardiac thoracicsurgery. METHODS: Preoperatively, each patient was assigned 2 independentestimations of risk according to the ASA-score (ASA grade, I-IV) and CRIscore (CRI grade, I-IV), respectively. RESULTS: Twenty-five patients diedwithin 4 weeks after the operation, the others survived the perioperativeperiod. The grading according to ASA as well as to the CRI score showed adirect correlation with the outcome: The higher the preoperative score, thehigher was the mortality rate. When various combinations of ASA and CRIwere tested, the lowest mortality rate was found in presence of ASA < or= III and CRI = I. Multivariate regression analysis showed that the ASAscore had an independent correlation with perioperative mortality, whereassuch a relationship was absent for CRI. CONCLUSIONS: The subjectiveassessment by an experienced anesthesiologist as expressed by the ASA-scoreis a valid method in the determination of the perioperative risk. CRI doesnot contribute additional information for the general perioperativerisk.

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