Self-reported fitness of American Society of Anesthesiologists class 3 patients undergoing endovascular aneurysm repair predicts patient survival.
BACKGROUND
Most patients undergoing elective endovascular aneurysm repair (EVAR) are classified American Society of Anesthesiologists (ASA) 3. However, the severity of systemic disease among these patients can vary, resulting in markedly different levels of fitness. In this study, we explored the hypothesis that ASA 3 patients with good self-reported exercise tolerance have better survival after EVAR.


METHODS
Data for EVAR patients classified ASA 3 were extracted retrospectively from a prospectively collected registry database. Patients were split into two groups according to fitness level, based on their self-reported ability to climb stairs or to walk briskly for 1 km. Patient survival for each group was assessed by Cox proportional hazards models.


RESULTS
During follow-up of 392 patients for a mean of 1.9 years, there were 64 deaths (16.3%), 13.4% in the more physically able group and 21.6% in the less able group. Self-reported inability to walk or to climb stairs was associated with increased risk of all-cause mortality (hazard ratio, 3.55; P < .0001). Following risk adjustment for a number of possible confounding variables, fitness remained significant (hazard ratio, 3.03; P = .0011).


CONCLUSIONS
This study has shown that among ASA 3 patients, self-reported exercise capacity is an excellent means of predicting survival. Physicians should consider the physical fitness of their ASA 3 patients when discussing treatment options.
Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, Australia.
Margaret
M
Boult
Data Management and Analysis Centre, School of Population Health, The University of Adelaide, Adelaide, Australia.
Stuart
S
Howell
Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, Australia.
Prue
P
Cowled
Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, Australia.
Tania
T
De Loryn
Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, Australia. Electronic address: robert.fitridge@adelaide.edu.au.
Robert
R
Fitridge
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality*; D017558:Elective Surgical Procedures / Q000401:mortality; D057510:Endovascular Procedures / Q000401:mortality*; D017079:Exercise Tolerance; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D057566:Self Report; D016019:Survival Analysis; D016896:Treatment Outcome