Inter-rater variability for the American Society of Anesthesiologists classification in patients undergoing hepato-pancreato-biliary surgery (MILESTONE-2) : international survey among surgeons and anaesthesiologists
(2024) In BJS Open 9(1). p.1-9- Abstract
BACKGROUND: Patients undergoing hepato-pancreato-biliary surgery are typically preoperatively assessed using the American Society of Anesthesiologists (ASA) classification, which is also used for case-mix adjustment when comparing centre outcomes. Studies determining the inter-rater variability of the ASA classification within hepato-pancreato-biliary surgery are currently lacking.
METHODS: An international survey was collected and a case-vignette study was performed (November 2022-April 2023) regarding the ASA classification in patients undergoing hepato-pancreato-biliary surgery among anaesthesiologists and surgeons from (inter)national societies. The survey consisted of 23 questions and eight case-vignettes. Primary analysis... (More)
BACKGROUND: Patients undergoing hepato-pancreato-biliary surgery are typically preoperatively assessed using the American Society of Anesthesiologists (ASA) classification, which is also used for case-mix adjustment when comparing centre outcomes. Studies determining the inter-rater variability of the ASA classification within hepato-pancreato-biliary surgery are currently lacking.
METHODS: An international survey was collected and a case-vignette study was performed (November 2022-April 2023) regarding the ASA classification in patients undergoing hepato-pancreato-biliary surgery among anaesthesiologists and surgeons from (inter)national societies. The survey consisted of 23 questions and eight case-vignettes. Primary analysis included descriptive statistics and the inter-rater variability was calculated using Light's Kappa.
RESULTS: Overall, 1283 participants from 55 countries responded: 1073 (84%) anaesthesiologists and 210 (16%) surgeons. The ASA classification was commonly used, both clinically 1003/1283 (78%) and for research 728/762 (96%). The majority of respondents (n = 1019, 79%) declared that ASA score impacted their perioperative strategy. There inter-rater variability was fair-moderate (Kappa 0.26-0.42) in all case-vignettes. Inter-rater variability differed within and among geographic regions for each case. Over 80% (n = 1138) of respondents stated that they would take the underlying disease (for example cancer) into account, but this changed the preferred ASA score within the case-vignettes by only 1%. Type of surgery changed the preferred score in the case-vignettes (13% difference). The most common suggestions to improve the ASA classification were to clarify whether type of operation should be considered, create a more extensive definition, and provide more examples.
CONCLUSIONS: Inter-rater variability was present within the ASA classification of patients undergoing hepato-pancreato-biliary surgery, which may impact perioperative strategy and hamper research results. Additional guidance to classify patients according to ASA is urgently needed. Until then, more objective measurements should be considered for case-mix adjustment within research.
(Less)
- author
- Augustinus, Simone
; Sijberden, Jasper P
; Bieze, Matthanja
; Agarwal, Vandana
; Aldrighetti, Luca A
; Alseidi, Adnan
; Bonofiglio, Francisco C
; Conlon, Kevin C P
; Donadello, Katia
; Erdmann, Joris
; Ferrone, Cristina
; Guertin, Michael
; Harter, Ronald
; Franceschetti, Maria E
; Fusai, Guiseppe K
; Groot Koerkamp, Bas
; Hackert, Thilo
; Jang, Jin-Young
; Kander, Thomas
LU
; Keck, Tobias
; Krzanicki, Dominik
; Lee, Ho-Jin
; Lewis, Keith
; Natalini, Giuseppe
; Nau, Carla
; Pawlik, Timothy M
; Pitt, Henry A
; Reineke, Rafaella
; Salvia, Roberto
; de Santibanes, Eduardo
; Shrikhande, Shailesh V
; Smith, Martin
; Szijarto, Attila
; Tingstedt, Bobby
LU
; Wei, Alice C
; Windsor, John
; Abu Hilal, Mohammed
; Pardo, Manuel
; Hollmann, Markus W
and Besselink, Marc G
(Less) - organization
- publishing date
- 2024-12-30
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Humans, Anesthesiologists/statistics & numerical data, Surgeons/statistics & numerical data, Observer Variation, Surveys and Questionnaires, Male, Female, United States, Biliary Tract Surgical Procedures, Societies, Medical, Digestive System Surgical Procedures/standards, Middle Aged
- in
- BJS Open
- volume
- 9
- issue
- 1
- pages
- 1 - 9
- publisher
- Wiley
- external identifiers
-
- pmid:40036750
- scopus:86000654490
- ISSN
- 2474-9842
- DOI
- 10.1093/bjsopen/zrae162
- language
- English
- LU publication?
- yes
- additional info
- © The Author(s) 2025. Published by Oxford University Press on behalf of BJS Foundation Ltd.
- id
- 1014f973-6168-4bb4-a3bc-a0c5285260af
- date added to LUP
- 2025-03-10 22:24:14
- date last changed
- 2025-06-08 06:57:09
@article{1014f973-6168-4bb4-a3bc-a0c5285260af,
abstract = {{<p>BACKGROUND: Patients undergoing hepato-pancreato-biliary surgery are typically preoperatively assessed using the American Society of Anesthesiologists (ASA) classification, which is also used for case-mix adjustment when comparing centre outcomes. Studies determining the inter-rater variability of the ASA classification within hepato-pancreato-biliary surgery are currently lacking.</p><p>METHODS: An international survey was collected and a case-vignette study was performed (November 2022-April 2023) regarding the ASA classification in patients undergoing hepato-pancreato-biliary surgery among anaesthesiologists and surgeons from (inter)national societies. The survey consisted of 23 questions and eight case-vignettes. Primary analysis included descriptive statistics and the inter-rater variability was calculated using Light's Kappa.</p><p>RESULTS: Overall, 1283 participants from 55 countries responded: 1073 (84%) anaesthesiologists and 210 (16%) surgeons. The ASA classification was commonly used, both clinically 1003/1283 (78%) and for research 728/762 (96%). The majority of respondents (n = 1019, 79%) declared that ASA score impacted their perioperative strategy. There inter-rater variability was fair-moderate (Kappa 0.26-0.42) in all case-vignettes. Inter-rater variability differed within and among geographic regions for each case. Over 80% (n = 1138) of respondents stated that they would take the underlying disease (for example cancer) into account, but this changed the preferred ASA score within the case-vignettes by only 1%. Type of surgery changed the preferred score in the case-vignettes (13% difference). The most common suggestions to improve the ASA classification were to clarify whether type of operation should be considered, create a more extensive definition, and provide more examples.</p><p>CONCLUSIONS: Inter-rater variability was present within the ASA classification of patients undergoing hepato-pancreato-biliary surgery, which may impact perioperative strategy and hamper research results. Additional guidance to classify patients according to ASA is urgently needed. Until then, more objective measurements should be considered for case-mix adjustment within research.</p>}},
author = {{Augustinus, Simone and Sijberden, Jasper P and Bieze, Matthanja and Agarwal, Vandana and Aldrighetti, Luca A and Alseidi, Adnan and Bonofiglio, Francisco C and Conlon, Kevin C P and Donadello, Katia and Erdmann, Joris and Ferrone, Cristina and Guertin, Michael and Harter, Ronald and Franceschetti, Maria E and Fusai, Guiseppe K and Groot Koerkamp, Bas and Hackert, Thilo and Jang, Jin-Young and Kander, Thomas and Keck, Tobias and Krzanicki, Dominik and Lee, Ho-Jin and Lewis, Keith and Natalini, Giuseppe and Nau, Carla and Pawlik, Timothy M and Pitt, Henry A and Reineke, Rafaella and Salvia, Roberto and de Santibanes, Eduardo and Shrikhande, Shailesh V and Smith, Martin and Szijarto, Attila and Tingstedt, Bobby and Wei, Alice C and Windsor, John and Abu Hilal, Mohammed and Pardo, Manuel and Hollmann, Markus W and Besselink, Marc G}},
issn = {{2474-9842}},
keywords = {{Humans; Anesthesiologists/statistics & numerical data; Surgeons/statistics & numerical data; Observer Variation; Surveys and Questionnaires; Male; Female; United States; Biliary Tract Surgical Procedures; Societies, Medical; Digestive System Surgical Procedures/standards; Middle Aged}},
language = {{eng}},
month = {{12}},
number = {{1}},
pages = {{1--9}},
publisher = {{Wiley}},
series = {{BJS Open}},
title = {{Inter-rater variability for the American Society of Anesthesiologists classification in patients undergoing hepato-pancreato-biliary surgery (MILESTONE-2) : international survey among surgeons and anaesthesiologists}},
url = {{http://dx.doi.org/10.1093/bjsopen/zrae162}},
doi = {{10.1093/bjsopen/zrae162}},
volume = {{9}},
year = {{2024}},
}