Assessment of the Preoperative Health Status Based on ASA PS versus ABCK : a Descriptive Study

Introduction: The ASA score presents the disadvantage of being subjective and its inter-individual concordance rate is criticized by several authors. This study aims at assessing the concordance between ABCK score and ASA score. Methods: It is a descriptive study conducted from 1st December 2013 to 30th August 2014 in 3 hospitals of Kinshasa city: Hôpital de l’amitié sinocongolaise, Hôpital Saint Joseph and Hôpital Marie Biamba Mutombo. All patients admitted for pre-anaesthesia consultation during the period of the study were assessed using ASA score and ABCK score. Were excluded from the study all pregnant women and children. Informed consent was obtained from all participants. The conformity of the new score with the ASA score was assessed using the kappa of Cohen test. Results: 768 patients out of them 449 women and 319 men were examined. The sex ratio was 1.4 in favour of women. The average age was 39.4 ± 16.8 years. Low blood pressure and anaemia were the main complications during and post surgery operations and were mostly found in stages 3 and 4 for the 2 scores. Blood transfusion was frequent in stages 3 and 4 for the 2 scores. Mortality tends to increase with the patient’ stage in the 2 groups (ASA: X2 = 25.98; p < 0.001 and ABCK: X2 = 29.70; p < 0.001). The risk of death was not related to the score used (p = 0.31 as per Fisher for class 3 and X2 = 0.52; p = 0.24 for class 4). And, there was an excellent concordance with a Kappa at 0.86 between ABCK and ASA (p < 0.001). Conclusion: This study revealed the existence of an excellent concordance between the 2 scores. INTRODUCTION The ASA score set up by the American Society of Anaesthetists (ASA) [1] is one of the classifications frequently used in anaesthesia [2,3]. Designed in 1941 [1], it is still considered to be the gold standard. The ASA score is a combination of all pre surgery examination results, expressed by a numerical value which is based on a fundamentally subjective estimation, independent of the patient’s age and of the type of surgery to be performed on the patient. It ranges patients into 6 stages of increasing gravity: ASA 1: Normal patient, ASA 2: Patient with moderate systemic abnormality, ASA 3: Patient with severe systemic abnormality, ASA 4: Patient with severe systemic abnormality which represents a constant life threat, ASA 5: a moribund patient whose survival is improbable without performing the surgery and ASA 6: Patient declared as in brain death status from whom organs are extracted for transplantation. Even though it is considered to be a good predictive indicator of the per operative surgery mortality [2,4], the ASA classification opens ways to diverse interpretations of the terms that define its different stages [5,6]. This makes some authors to consider it as vague and subjective [7]. From its introduction, several studies have shown evidence of disagreements and inconsistencies on the ASA score rating [5,8,9]. Local diseases, even though they can alter the physical status, do not influence the ASA classification. The word Central Bringing Excellence in Open Access   Bula-Bula et al. (2016) Email: Int J Clin Anesthesiol 4(3): 1060 (2016) 2/5 “systemic” brings more confusion in this classification: the myocardial infarction, for example, although a severe disease, is a “local” condition and should not be considered as a “systemic” disease in this classification; despite the low rates of post-surgery recovery that is observed among this kind of patients [10]. In the same way, conditions like cirrhosis of the liver, perirenal abscess, infected wounds, intestinal perforation, skull fracture, although they all greatly affect the physical status of the patient, cannot be labelled as “systemic disease”, which means a generalized disorder affecting the whole body just like high blood pressure or diabetes [10]. These discrepancies made some medical facilities to establish their own assessment methods [11,12]. To mention some, the Acute Physiology And Chronic Health Evaluation (APACHE) [11], the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (Possum) [13] and more others. However, none of these existing pre-surgery assessment systems could reach the same level of use like the ASA [14]. In sub-Saharan Africa including in D.R. Congo, the anaesthesia is most of the time performed by a less qualified personnel [15,16]. Some authors have shown that insufficiency of material means and lack of qualified personnel is common in performing the anaesthesia act in developing countries [17,18]; this exposes the ASA classification to a more important risk of subjectivity. To overcome this difficulty, this study is aiming at proposing a simpler and less subjective score, presented in clearer terms, concise and accurate, the ABCK, which could be utilized besides the ASA or replace it.