P2516 - American Society of Anesthesiologists Physical Status and Impact on Endoscopic Procedural Times: A Single Center Experience

William D. Davis, DO¹, Camille H. Boustani, MD¹, Kristofer Muzzi, BS¹, Lelan Bailey, BA¹, Ahmed Alsaiari, MD¹, Mark Real, MD¹, Nadim Haddad, MD², Joseph J. Jennings, MD^2
1MedStar Georgetown University Hospital, Washington, DC; ²Georgetown University Hospital, Washington, DC

Introduction: The American Society of Anesthesiologists physical status (ASA-PS) is a scoring system that is ubiquitously utilized for preoperative assessment of patients undergoing anesthesia. It is well established in literature that a higher ASA-PS correlates with post-operative morbidity and mortality. The purpose of our study was to determine if higher ASA-PS score can also serve as a predictor of longer time spent in different aspects of endoscopic procedures, including pre-endoscopy preparation, endoscopy, and post-endoscopy times.

Methods: Our study is a retrospective, single-center analysis of patient data during the month of October in both 2019 and 2020 that had undergone endoscopic procedures in both inpatient and outpatient settings. Patients were grouped by ASA-PS score (ASA-PS 1/2 or 3/4) and the timing of their procedure (October 2019 or October 2020). Outcomes of interest included patient preparation time, endoscopy suite preparation time, physician arrival time, endoscopy room delay, procedural time, post-procedural time and time to last image capture. Outcomes were analyzed using two-sample t-test.

Results: Patient data is summarized in Table 1. A total of 1915 patients were reviewed. Subgroup analysis showed ASA 1/2 (n=582) and 3/4 (n=392) in 2019 (n=974) along with ASA 1/2 (n=528) or 3/4 (n=413) in 2020 (n=941). Higher ASA-PS correlated with statistically significant longer time intervals for each of the outcomes of interest for both 2019 and combined data set. In 2020 however, both physician arrival time and procedural time did not meet statistical significance for higher ASA-PS.

Discussion: Our retrospective study demonstrated longer overall peri-procedural times for higher ASA-PS score. Due to greater risks of complications with higher ASA-PS, it can be speculated that longer preparation time is allocated to these patients. Additionally, as this data was obtained from a teaching hospital, fellows assist in many procedures, potentially accounting for prolonged procedure times in higher risk patients. We can also hypothesize that the lack of statistically significance of physician arrival and procedure time in 2020 may be related to the Covid-19 pandemic in attempts of decreasing house staff exposure. These delays may have implications on outpatient endoscopy that takes place at tertiary care centers, where higher acuity patients undergo procedures, versus at ambulatory centers.

	2019			2020			Total Data
Time (minutes)	ASA 1-2 (N=582) Mean	ASA 3-4 (N=392) Mean	P-Value	ASA 1-2 (N=528) Mean	ASA 3-4 (N=413) Mean	P-Value	ASA 1-2 (N=1110)	ASA 3-4 (N=805)	P-Value
Preparation	17.49	19.10	0.0266*	16.35	17.91	0.016*	16.95	18.49	0.0014*
Endoscopy suite setup	4.37	5.41	0.0062*	4.29	5.38	0.0083*	4.37	5.40	0.0002*
Physician arrival	6.48	8.39	0.0002*	6.07	6.22	0.74	6.29	7.28	0.0041*
In room delay	5.77	8.49	1.32x10-6*	7.22	8.31	0.0418*	6.46	8.40	5.22x10-7*
Procedure	16.38	20.69	3.85x10-7*	19.20	20.51	0.0869*	17.72	20.55	4.46x10-7*
Post-Procedure	18.25	21.45	0.034*	19.49	22.15	0.0426*	18.84	21.81	0.0029
Last endoscopy image capture	16.63	22.28	9.86x10-13*	17.58	19.92	0.0017*	17.08	21.07	1.76x10-13*

Table: Title: Patient procedural times by year and ASA-PS score
Footnote: *Denotes statistical significance


Disclosures:
William Davis indicated no relevant financial relationships.
Camille Boustani indicated no relevant financial relationships.
Kristofer Muzzi indicated no relevant financial relationships.
Lelan Bailey indicated no relevant financial relationships.
Ahmed Alsaiari indicated no relevant financial relationships.
Mark Real indicated no relevant financial relationships.
Nadim Haddad indicated no relevant financial relationships.
Joseph Jennings indicated no relevant financial relationships.


William D. Davis, DO¹, Camille H. Boustani, MD¹, Kristofer Muzzi, BS¹, Lelan Bailey, BA¹, Ahmed Alsaiari, MD¹, Mark Real, MD¹, Nadim Haddad, MD², Joseph J. Jennings, MD². P2516 - American Society of Anesthesiologists Physical Status and Impact on Endoscopic Procedural Times: A Single Center Experience, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.