Is ASA Classification Useful in Risk Stratification for EBUS-TBNA?

Abstract

Objective: The efficiency and safety of American Society of Anesthesiologists (ASA) in predicting peri-bronchoscopic morbidity and mortality is an increasing concern as endobronchial ultrasound (EBUS) gains popularity. The purpose of this study is to investigate whether the ASA classification is useful in risk stratification for EBUS.

Material and methods: The patients who underwent EBUS and had anesthesia assessment before the procedure, were enrolled. Data about the age, gender, comorbidity, ASA score, and complications were collected retrospectively from their medical files.

Results: A total of 221 patients with ASA class documentation in anesthesia assessment before EBUS, were enrolled in the study. The study population comprised 125 (56.6%) male and 96 (43.4%) female patients with a mean age of 59.08 ± 11.15 years. Comorbidity was present in 161 patients (72.9%), of which hypertension (64%) was the most common. There was no significant difference between the pre-bronchoscopic and post-bronchoscopic values of oxygen saturation (SpO2), systolic and diastolic blood pressure, and heart rate (respectively P = .83, P = .12, P = .15, P = .89). The most frequent complication during EBUS was desaturation that happened in 109 (49.3%) patients. There was no correlation between ASA score and complications (P > .999). There was no statistically significant difference in ASA scores with respect to complications (P = .14). The sensitivity and the specificity of pre-bronchoscopic evaluation in predicting the post-anesthesia care unit (PACU)/intensive care unit (ICU) requirement, were 83.3% and 61%, respectively. The significant deciding factors for post-bronchoscopic follow-up sites were found to be as ASA and age (respectively, P = .025, P < .001).

Conclusion: There was no correlation between ASA and complications. To organize PACU/ICU beds more efficiently, a better scoring system is required.