Comparison of perioperative risk assessment using ASA PS (American Society of Anesthesiologist Physical Status) and NARCO-SS (Neurological, Airway, Respiratory, Cardiovascular, Other &ndash; Surgical Severity) scores among patients who underwent anesthesi

Aaron Adolf  R. Abad,; Janette  T. Fusilero-pascual,

Comparison of perioperative risk assessment using ASA PS (American Society of Anesthesiologist Physical Status) and NARCO-SS (Neurological, Airway, Respiratory, Cardiovascular, Other – Surgical Severity) scores among patients who underwent anesthesi

Aaron Adolf R. Abad | Janette T. Fusilero-pascual

Abstract:

OBJECTIVE: To compare the performance of the following scoring systems, the ASA PS and the NARCO – SS in terms of predicting perioperative outcomes in pediatric patients who underwent anesthesia at the Philippine Children's Medical Center. MATERIALS AND METHODS: This is a retrospective cohort chart review study; ASA-PS and NARCO-SS scores were assigned to 361 children, and predefined perioperative adverse events and escalation of care were recorded. Spearman’s correlation was used to determine the relationship between outcomes and scores. The predictive performance of ASA-PS and NARCO-SS was evaluated by area under the ROC curve. RESULTS: NARCO-SS and ASA-PS scores had significant Spearman’s correlation coefficients with perioperative outcomes. Individual categories of NARCO demonstrate a weak correlation with the outcomes of interest. Both the ASA and NARCO-SS scoring systems were able to correctly identify patients requiring escalation of care and those who experienced adverse events, particularly at higher score levels. The NARCO-SS showed greater discrimination than the ASA-PS for escalation of care (AUC-ROC 0.8622 vs 0.8273, Chi2 = 4.02, p-value = 0.0450) and for adverse events (AUC- ROC 0.8185 vs 0.0.792, Chi2 = 1.95, p-value =0.1623). CONCLUSION: We validated the use of NARCO-SS as a risk stratification tool with better discriminating ability in predicting for escalation of care compared to ASA-PS. Further studies are suggested to assess the interrater reliability of

References:

1. Ivana Bures, Ljiljana popovic., Assessment of Preoperative Risk in Children. Portal of Croatian Scientific and Professional Journals. Medicinski Vjesnik, Vol. 140 No. 1 7-8, 2018

2. Cronjé L. A review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents. Southern African Journal of Anaesthesia and Analgesia. 2015 Nov 2;21(6):147–53.

3. American Society of Anesthesiologists. ASA Physical Status Classification System [Internet]. www.asahq.org. 2020. Available from: https://www.asahq.org/standards-and-practice-parameters/statement-on-asa-physical-status-classification-system

4. P.H.K. Mak, R.C.H. Campbell, M.G. Irwin. The ASA Physical Status Classification: Inter-Observer Consistency. Anesthesia Intensive Care 2002; 30: 633-640

5. Jaqueline Ragheb MD FFARCSI, Shobha Malviya MD, Constance Burke BSN RN and Paul Reynolds MD. An Assessment of Interrater Reliability of the ASA Physical Status Classification in Pediatric Surgical Patients. Pediatric Anesthesia 2006 16: 928 – 931

6. Laura L. Burgoyne BM BS, Matthew P. Smeltzer MS, Lilia A. Pereiras MD, Angela L. Norris RN BSN and Alberto J. De Armendi MD AM. How do well do Pediatric Anesthesiologist Agree when Assigning ASA Physical Status Classifications to their Patients? Pediatric Anesthesia 2007 17: 956 – 962

7. Ferrari LR, Leahy I, Staffa SJ, Johnson C, Crofton C, Methot C, et al. One Size Does Not Fit All: A Perspective on the American Society of Anesthesiologists Physical Status Classification for Pediatric Patients. Anesthesia and Analgesia [Internet]. 2020 Jun 1;130(6):1685–92. Available from: https://pubmed.ncbi.nlm.nih.gov/31219919/

8. D. Mayhew, V. Mendonca and B.V.S. Murthy A Review of ASA Physical Statrus – Historical Perspectives and Modern Development. Anesthesia 2019, 74, 373 – 379 Review Article

9. S. Malviya, T, Voepel-Lewis, S.D. Chiravuri, K. Gibbons, W.T. Chimbira, O. O. Nafiu, P.I. Reynolds and A.R. Tait. Does an Objective System-based Approach Improve Assessment of Perioperative Risk in Children? A Preliminary Evaluation of the ‘NARCO’. British Journal of Anesthesia 106 (3): 352-8 (2011)

10. Ashwin N. Udupa, Maghavi N. Ravindra, Y.R. Chandrika, K. R. Chandrakala, B. Bindu and Mehernoor F. Watcha. Comparison of Pediatric Perioperative Risk Assessment by ASA Physical Status and the NARCO – SS (Neurological, Airway, Respiratory, Cardiovascular, other – Surgical Severity) Scores.,John Wiley and Sons Ltd. Pediatric Anesthesia 25 (2015) 309-316

11. Udupa AN, Majmudar AA, Tran L. A systematic review of neurological airway respiratory cardiovascular other‐surgical severity (NARCO‐SS) score as a pediatric perioperative scoring system. Pediatric Anesthesia. 2024 Feb 1;

12. Munkonka, Martha, Bruce C Bvulani, Hazel Mumpanshya, and Mulewa Mulenga. 2024. “The Use of Narco SS Score in Predicting Adverse Events in Children Undergoing Major Elective Abdominal Surgery at the University Teaching Hospital, Lusaka, Zambia.” African Journal of Paediatric Surgery 21 (3): 166–71. https://doi.org/10.4103/ajps.ajps_7_22