| Contributors: |
Augustinus, S.; Sijberden, J. P.; Bieze, M.; Agarwal, V.; Aldrighetti, L.; Alseidi, A.; Bonofiglio, F. C.; Conlon, K. C. P.; Donadello, K.; Erdmann, J.; Ferrone, C.; Guertin, M.; Harter, R.; Franceschetti, M. E.; Fusai, G. K.; Koerkamp, B. G.; Hackert, T.; Jang, J. -Y.; Kander, T.; Keck, T.; Krzanicki, D.; Lee, H. -J.; Lewis, K.; Natalini, G.; Nau, C.; Pawlik, T. M.; Pitt, H. A.; Reineke, R.; Salvia, R.; De Santibanes, E.; Shrikhande, S. V.; Smith, M.; Szijarto, A.; Tingstedt, B.; Wei, A. C.; Windsor, J.; Hilal, M. A.; Pardo, M.; Hollmann, M. W.; Besselink, M. G. |
| Description: |
Background: Patients undergoing hepato-pancreato-biliary surgery are typically preoperatively assessed using the American Society of Anesthesiologists (ASA) classification, which is also used for case-mix adjustment when comparing centre outcomes. Studies determining the inter-rater variability of the ASA classification within hepato-pancreato-biliary surgery are currently lacking.Methods: An international survey was collected and a case-vignette study was performed (November 2022–April 2023) regarding the ASA classification in patients undergoing hepato-pancreato-biliary surgery among anaesthesiologists and surgeons from (inter)national societies. The survey consisted of 23 questions and eight case-vignettes. Primary analysis included descriptive statistics and the inter-rater variability was calculated using Light’s Kappa.Results: Overall, 1283 participants from 55 countries responded: 1073 (84%) anaesthesiologists and 210 (16%) surgeons. The ASA classification was commonly used, both clinically 1003/1283 (78%) and for research 728/762 (96%). The majority of respondents (n = 1019, 79%) declared that ASA score impacted their perioperative strategy. There inter-rater variability was fair–moderate (Kappa 0.26–0.42) in all case-vignettes. Inter-rater variability differed within and among geographic regions for each case. Over 80% (n = 1138) of respondents stated that they would take the underlying disease (for example cancer) into account, but this changed the preferred ASA score within the case-vignettes by only 1%. Type of surgery changed the preferred score in the case-vignettes (13% difference). The most common suggestions to improve the ASA classification were to clarify whether type of operation should be considered, create a more extensive definition, and provide more examples. Conclusions: Inter-rater variability was present within the ASA classification of patients undergoing hepato-pancreato-biliary surgery, which may impact perioperative strategy and hamper research results. Additional guidance to ... |