Analysis of Perioperative Findings of Cholecystectomy in relation to American Society of Anesthesiologists (ASA) Status
DOI:
https://doi.org/10.51253/pafmj.v74i3.6952Keywords:
Anesthesia, Bile, Cystic Duct, Gallbladder, Laparoscopic CholecystectomyAbstract
Objective: To analyze the role of ASA status in carrying out laparoscopic cholecystectomies by evaluating the perioperative findings of patients.
Study Design: Cross-sectional study.
Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Jan 2019 to Jan 2021.
Methodology: Laparoscopic cholecystectomies were performed on 385 patients with symptomatic gallstones. The inclusion criteria comprised of symptomatic cholelithiasis, acute cholecystitis and chronic cholecystitis. Data for the perioperative findings such as gallbladder grades, bile, cystic duct, cystic artery and Common Bile Duct were recorded during the study.
Results: The study included 226(59%) female patients and 159(41%) males. The mean age was 48.15±15.5 years. There were 145(37.66%) patients in American Society of Anesthesiologists Classification ASA-I, 174(45.20%) patients in ASA-II and 66(17.14%) in ASA-III. Results showed that the abnormalities of cystic duct were 34(23.4%) in ASA-I, 68(39.1%) in ASA-II and 43(65.2%) in ASA-III. For CBD, they were 7(4.8%) in ASA-I, 49(28.2%) in ASA-II and 44(66.2%) in ASA-III. The complications of cystic artery and bile were 34(23.4%) in ASA-I, 60(34.5%) in ASA-II, 46(69.7%) in ASA-III and 82(56.6%) in ASA-I, 119(68.4%) in ASA-II, 50(75.8%) in ASA-III respectively. The gallbladder grades I were 27(18.6%) in ASA-I and (4.5%) in ASA-III whereas, grades V were 7(4.8%) in ASA-I and 20(30.3%) in ASA-III.
Conclusion: Peri-operative morbidity increased with increasing ASA status, therefore, there is a significant relationship between ASA Status and peri-operative findings.
Downloads
References
Waleed MS, Khawaja UA, Akhtar M, Sadiq W. Laparoscopic Cholecystectomy: An Early Experience at A Tertiary Care Hospital in Islamabad. Comm Med Pub Health Rep 2020; 1(4). https://doi.org/10.38207/jmcrcs20201053
Hela AH, Khandwaw HM, Kumar R, Samad MA. Experience of Laparoscopic Cholecystectomies in a Tertiary Care Hospital: a Retrospective Study. Galician Med J 2020; 27(4): E202043.
https://doi.org/10.21802/gmj.2020.4.3
Lucocq J, Scollay J, Patil P. Defining Prolonged Length of Stay (PLOS) Following Elective Laparoscopic Cholecystectomy and Derivation of a Preoperative Risk Score to Inform Resource Utilization, Risk Stratification, and Patient Consent. Ann Surg 2023; 277(5): e1051-e1055.
https://doi.org/10.1093/bjs/znab430.057
Kannaujia AK, Gupta A, Verma S, Srivastava U, Haldar R, Jasuja S. Importance of Routine Laboratory Investigations Before Elective Surgery. Discoveries 2020; 8(3): e114.
https://doi.org/10.15190/d.2020.11
Singh V, Datta R, Sasidharan S, Tomar L. Spectrum of Postoperative Admissions in the Intensive Care Unit of a Tertiary Care Hospital: An Indian Update. Saudi Crit Care J 2020; 4(3): 96-102. https://doi.org/10.4103/sccj.sccj_24_20
Cevik B, Yuce Y. Risk Assessment in Surgical Patients: American Society of Anesthesiologist’s (ASA) Classification vs Intraoperative Therapeutic and Diagnostic Interventions (I-ITS. Am J Clin Med Res 2018; 6(1): 15-19.
https://doi.org/10.12691/ajcmr-6-1-4
Havens JM, Columbus AB, Seshadri AJ, Brown CVR. Risk stratification tools in emergency general surgery. Trauma Surg Acute Care Open 2018; 3(1): e000160.
https://doi.org/10.1136/tsaco-2017-000160
Gen Li, Jeremy P. Walco, Dorothee A. Mueller, Jonathan P Wanderer, Robert E. Freundlich. Reliability of the ASA Physical Status Classification System in Predicting Surgical Morbidity: a Retrospective Analysis. J Med Syst Vol 2021; 45(9): 83.
https://doi.org/10.1007/s10916-021-01758-z
Madni TD, Leshikar DE, Minshall CT, Nakonezny PA, Cornelius CC, Imran JB, et al. The Parkland grading scale for cholecystitis. Am J Surg 2018; 215(4): 625-630.
https://doi.org/10.1016/j.amjsurg.2017.05.017
Kamangar F, Islami F. Sample Size Calculation for Epidemiologic Studies: Principles and Methods. Arch Iran Med 2013; 5(16). https://doi.org/10.1177/096228029500400404
Lupei MI, Chipman JG, Beilman GJ, Oancea SC, Konia MR. The Association Between ASA Status and Other Risk Stratification Models on Postoperative Intensive Care Unit Outcomes. Anesth Analg 2014; 5(118): 989–994.
https://doi.org/10.1213/ane.0000000000000187
Abdul-Razack GS, Avinash K, Manjunath BD, Harindranath HR, Archana CS. Pre-operative evaluation with parkland grading system in assessing difficult laparoscopic cholecystectomy and expectant operative and post-operative complications. Int J Surg Sci 2019; 3(3): 20–25.
https://doi.org/10.33545/surgery.2019.v3.i3a.141
Shea-Jesse JA, Berlin-Dale A, Bachwich R, Staroscik RN, Malet PF. Indications for and Outcomes of Cholecystectomy. Ann Surg 1998; 3(227): 343–350.
https://doi.org/10.1097/00000658-199803000-00005
Lunn JN. The National Confidential Enquiry into Perioperative Deaths. J Clin Monit Comput 1994; 6(10): 426–428.
https://doi.org/10.1007/bf01618430
De Cassai A, Boscolo A, Tonetti T, Ban I, Ori C. Assignment of ASA-physical status relates to anesthesiologists' experience: a survey-based national-study. Korean J Anesthesiol 2019; 72(1): 53-59. https://doi.org/10.4097/kja.d.18.00224
Rerknimitr R, Pham KC. Practical Approaches for High-Risk Surgical Patients with Acute Cholecystitis: The Percutaneous Approach versus Endoscopic Alternatives. Clin Endosc 2020; 53(6): 678-685.https://doi.org/10.5946/ce.2019.186
Kuan LL, Oyebola T, Mavilakandy A, Dennison AR. Retrospective Analysis of Outcomes Following Percutaneous1. Waleed MS, Khawaja UA, Akhtar M, Sadiq W. Laparoscopic Cholecystectomy: An Early Experience at A Tertiary Care Hospital in Islamabad. Comm Med Pub Health Rep 2020; 1(4). https://doi.org/10.38207/jmcrcs20201053
Hela AH, Khandwaw HM, Kumar R, Samad MA. Experience of Laparoscopic Cholecystectomies in a Tertiary Care Hospital: a Retrospective Study. Galician Med J 2020; 27(4): E202043.
https://doi.org/10.21802/gmj.2020.4.3
Lucocq J, Scollay J, Patil P. Defining Prolonged Length of Stay (PLOS) Following Elective Laparoscopic Cholecystectomy and Derivation of a Preoperative Risk Score to Inform Resource Utilization, Risk Stratification, and Patient Consent. Ann Surg 2023; 277(5): e1051-e1055.
https://doi.org/10.1093/bjs/znab430.057
Kannaujia AK, Gupta A, Verma S, Srivastava U, Haldar R, Jasuja S. Importance of Routine Laboratory Investigations Before Elective Surgery. Discoveries 2020; 8(3): e114.
https://doi.org/10.15190/d.2020.11
Singh V, Datta R, Sasidharan S, Tomar L. Spectrum of Postoperative Admissions in the Intensive Care Unit of a Tertiary Care Hospital: An Indian Update. Saudi Crit Care J 2020; 4(3): 96-102. https://doi.org/10.4103/sccj.sccj_24_20
Cevik B, Yuce Y. Risk Assessment in Surgical Patients: American Society of Anesthesiologist’s (ASA) Classification vs Intraoperative Therapeutic and Diagnostic Interventions (I-ITS. Am J Clin Med Res 2018; 6(1): 15-19.
https://doi.org/10.12691/ajcmr-6-1-4
Havens JM, Columbus AB, Seshadri AJ, Brown CVR. Risk stratification tools in emergency general surgery. Trauma Surg Acute Care Open 2018; 3(1): e000160.
https://doi.org/10.1136/tsaco-2017-000160
Gen Li, Jeremy P. Walco, Dorothee A. Mueller, Jonathan P Wanderer, Robert E. Freundlich. Reliability of the ASA Physical Status Classification System in Predicting Surgical Morbidity: a Retrospective Analysis. J Med Syst Vol 2021; 45(9): 83.
https://doi.org/10.1007/s10916-021-01758-z
Madni TD, Leshikar DE, Minshall CT, Nakonezny PA, Cornelius CC, Imran JB, et al. The Parkland grading scale for cholecystitis. Am J Surg 2018; 215(4): 625-630.
https://doi.org/10.1016/j.amjsurg.2017.05.017
Kamangar F, Islami F. Sample Size Calculation for Epidemiologic Studies: Principles and Methods. Arch Iran Med 2013; 5(16). https://doi.org/10.1177/096228029500400404
Lupei MI, Chipman JG, Beilman GJ, Oancea SC, Konia MR. The Association Between ASA Status and Other Risk Stratification Models on Postoperative Intensive Care Unit Outcomes. Anesth Analg 2014; 5(118): 989–994.
https://doi.org/10.1213/ane.0000000000000187
Abdul-Razack GS, Avinash K, Manjunath BD, Harindranath HR, Archana CS. Pre-operative evaluation with parkland grading system in assessing difficult laparoscopic cholecystectomy and expectant operative and post-operative complications. Int J Surg Sci 2019; 3(3): 20–25.
https://doi.org/10.33545/surgery.2019.v3.i3a.141
Shea-Jesse JA, Berlin-Dale A, Bachwich R, Staroscik RN, Malet PF. Indications for and Outcomes of Cholecystectomy. Ann Surg 1998; 3(227): 343–350.
https://doi.org/10.1097/00000658-199803000-00005
Lunn JN. The National Confidential Enquiry into Perioperative Deaths. J Clin Monit Comput 1994; 6(10): 426–428.
https://doi.org/10.1007/bf01618430
De Cassai A, Boscolo A, Tonetti T, Ban I, Ori C. Assignment of ASA-physical status relates to anesthesiologists' experience: a survey-based national-study. Korean J Anesthesiol 2019; 72(1): 53-59. https://doi.org/10.4097/kja.d.18.00224
Rerknimitr R, Pham KC. Practical Approaches for High-Risk Surgical Patients with Acute Cholecystitis: The Percutaneous Approach versus Endoscopic Alternatives. Clin Endosc 2020; 53(6): 678-685.https://doi.org/10.5946/ce.2019.186
Kuan LL, Oyebola T, Mavilakandy A, Dennison AR. Retrospective Analysis of Outcomes Following Percutaneous Cholecystostomy for Acute Cholecystitis. World J Surg 2020; 1(44). https://doi.org/10.1007/s00268-020-05491-5
Baral S, Chhetri RK, Thapa N. Utilization of an Intraoperative Grading Scale in Laparoscopic Cholecystectomy: A Nepalese Perspective. Gastroenterol Res Pract. 2020; 2020: 8954572. https://doi.org/10.1155/2020/8954572
Catherine-Kuza CM, Matsushima K, Mack WJ, Pham C, Hourany T, Lee J et al. The role of the American Society of anesthesiologists physical status classification in predicting trauma mortality and outcomes. Am J Surg 2019; 218(6): 1143-1151.
https://doi.org/10.1016/j.amjsurg.2019.09.019.
Okamoto K, Suzuki K,Takada T, Steven M. Strasberg,Horacio J. Asbun,Itaru Endo. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepato-Biliary-Pancreat Sci 2017; 26(11): 534–534. https://doi.org/10.1002/jhbp.526
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Faheem ., Umar Fayyaz Ghani, Yousaf Ali Shah, Uzma Javed Gul, Rohan Qamar, Rashid Iqbal Khan
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
