Associations between preoperative american society of anesthesiologists physical status classification and postoperative outcomes in patients undergoing vertebroplasty.

OBJECTIVE: The American Society of Anesthesiologists (ASA) physical status classification system is a preoperative evaluation regarding the risk of anesthesia during surgery. We investigated associations of ASA scores with postoperative Patient-Reported Outcome Measures (PROMs) and long-term survival rate in patients undergoing vertebroplasty. METHODS: We retrospectively identified patients undergoing vertebroplasty for vertebral compression fractures from 2018 to 2020. PROMs were assessed using the Oswestry Disability Index (ODI) and EuroQol-5D (EQ-5D) prior to surgery and at postoperative follow-up. Patients were categorized by preoperative ASA scores (≤ 2 vs. ≥ 3). Between-group differences in postoperative changes of PROMs were compared. All-cause mortality was confirmed through March 2022. The association of ASA classification with all-cause mortality was examined using Cox-proportional hazard models. RESULTS: A total of 199 patients were analyzed (ASA ≤ 2, n = 95; ASA ≥ 3, n = 104). Patients with an ASA ≤ 2 experienced a greater improvement in ODI (mean [SD] -35.8 [18.7] vs. -25.5 [17.4], p = 0.001) and EQ-5D (mean [SD] 0.42 [0.22] vs. 0.33 [0.26], p = 0.042) at 12-month follow-up than those having an ASA ≥ 3. After a median follow-up of 2.2-years, patients having a higher ASA score (≥ 3 vs. ≤ 2) experienced a greater risk of all-cause mortality (HR = 3.315, 95% CI 1.330 to 8.258, p = 0.010). CONCLUSION: A lower ASA score (≤ 2 vs. ≥ 3) was associated with a greater improvement in PROMs and better long-term survival after vertebroplasty for compression fractures. ASA classification may help identify high-risk patients, even in less invasive surgeries.