Importance of preoperative assessment: a view of anaesthetic outpatient at JPMC Karachi

ABSTRACT

To evaluate the patients preoperatively and follow them for any significant morbidity or mortality in peri or post operative period in relation to American Society of Anesthesiologist [ASA] physical status grading system. Design: A prospective study on 400 patients visiting our Preanaesthetic Outpatient Clinic in one month. Setting: Anaestnetic Outpatient clinic at Jinnah Postgraduate Medical Centre and their follow up in theatre and surgical wards. Subjects: Four hunderd patients Four hundred patients scheduled for elective surgery were evaluated in one month. 70% were new while 30% were reassessed. 78.75% were fit for anaesthesia while 21.25% were called back for reassessment. 79,25% were scheduled for major to moderate surgery while 20.25% for minor surgery. 21% patients were in ASA physical status grade I, 54% in ASA grade II, 22.50% were in ASA grade III while 2.5% in ASA grade Iv showing significant distribution of proportion with P< 0.001. Maximum patients i.e. 46.25% had cardiovascular problems while 32.25% had respiratory diseases, 4,50% were diabetic while 14.25% had haenologlobin below 10 gm%. There was no peri operative mortality in this series. Patients in ASA grade I and II had no postoperative mortality as well while morbidity was 2.38% and 3.24% respectively. In ASA grade III and IV mortality was 3.30% and 30% with morbidity of 11.11% and 40%respectively. Total mortality in this series was 1.5% and morbidity was 5.75%. By evaluating the patients preoperatively unsuspected abnormalities were detected and patients with associated problems were optimized clinically. A definite correlation was found between ASA physical status of the patients and their overall outcome: