title: Abdominal Contouring: Can the American Society of Anesthesiologists Classification System Help Determine When to Say No?
abstract: BACKGROUND
  The purpose of this study was to determine whether the American Society of Anesthesiologists classification system could be used preoperatively to identify patients at high risk for complications after abdominal contouring.
  
  
  METHODS
  Using the National Surgical Quality Improvement Program database from 2007 to 2012, patients undergoing abdominal contouring procedures were identified and stratified by American Society of Anesthesiologists class. The primary outcome was any complication within 30 days. Secondary outcomes included minor wound, major surgical, and medical complication. Adjusted odds ratios were calculated using logistic regression.
  
  
  RESULTS
  A total of 3637 patients were analyzed; 14.6 percent of patients were class I, 59.1 percent were class II, 23.4 percent were class III, and 2.9 percent were class IV. Overall complication and mortality rates were 12 percent and 0.2 percent, respectively. There was a significant trend of increasing odds of any complication with increasing class (class I, OR, 1.0; class II, OR, 1.5; class III, OR, 2.5; class IV, OR, 5.6; p-trend < 0.001). This trend was seen consistently for minor wound complications, medical complications, and major surgical complications (p = 0.007, p = 0.005, and p = 0.001, respectively).
  
  
  CONCLUSIONS
  The American Society of Anesthesiologists classification system, which is simple and universally applicable, appears to predict significant complications and can be used to rapidly screen patients before abdominal contouring. Furthermore, the authors' results can be used to inform patient-physician discussion about the risks incurred when undergoing these procedures based on their individual class. Together with optimization of high-risk patients, patient selection using American Society of Anesthesiologists classification may prevent complications and improve outcomes.
  
  
  METHODS
  Risk, II.
authors.affiliation: Bronx, N.Y.|From the Albert Einstein College of Medicine and the Montefiore Medical Center.
authors.forename: Olatomide T
authors.initials: OT
authors.lastname: Familusi
authors.affiliation: Bronx, N.Y.|From the Albert Einstein College of Medicine and the Montefiore Medical Center.
authors.forename: Matthew
authors.initials: M
authors.lastname: Doscher
authors.affiliation: Bronx, N.Y.|From the Albert Einstein College of Medicine and the Montefiore Medical Center.
authors.forename: Oscar J
authors.initials: OJ
authors.lastname: Manrique
authors.affiliation: Bronx, N.Y.|From the Albert Einstein College of Medicine and the Montefiore Medical Center.
authors.forename: Joseph
authors.initials: J
authors.lastname: Shin
authors.affiliation: Bronx, N.Y.|From the Albert Einstein College of Medicine and the Montefiore Medical Center.
authors.forename: Teresa
authors.initials: T
authors.lastname: Benacquista
mesh_terms: D061645:Abdominoplasty; D000328:Adult; D000368:Aged; D000776:Anesthesiology; D000066491:Clinical Decision-Making / Q000379:methods*; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D014481:United States