ASA Prediction Using Health Data and Medication Use

Completed

• Conditions: ASA-PS Classification

• Registration Number: NCT06629350
• Lead Sponsor: Erasmus Medical Center

Brief Summary

The development of a machine learning algorithm that predicts American Society of Anesthesiologist-Physical Status (ASA-PS) based on preoperative variables would not only improve clinical decision-making in patient risk stratification but also offer a more reliable tool for administrative and regulatory uses. Therefore, the development of such a machine learning tool presents a significant opportunity to advance both the science and practice of perioperative care. Incorporating medication use into the algorithm could further enhance its predictive power, as it is closely linked to systemic disease. This addition could help refine the ASA-PS classification, making it an even more valuable tool in the clinical setting.

Detailed Description

The American Society of Anesthesiologists Physical Status (ASA-PS) classification system is a widely used tool for assessing surgical fitness and other clinical contexts. However, its inherent subjectivity and heavy reliance on clinician judgment can lead to inconsistencies in patient risk stratification, a critical component of perioperative care. Furthermore, the ASA-PS system has been adopted for various administrative and regulatory purposes beyond its original intent, such as quality assessment by the Dutch Health and Youth Care Inspectorate (IGJ), compensation decisions by private payers in the USA, patient triage, and determining suitability for certain types of surgery.

Given the broad and critical applications of the ASA-PS system, enhancing its precision and objectivity is of paramount importance. One way to achieve this is through the development of a machine learning algorithm that predicts ASA-PS based on preoperative variables. Anesthesiologists base the ASA-PS score on the presence of systemic diseases, which can be inferred from medication use. By leveraging data such as Anatomical Therapeutic Chemical (ATC) codes, BMI, sex, age, routinely collected preoperative health data, and medication use, this algorithm could provide a more consistent and objective measure of ASA-PS.

This would not only improve clinical decision-making in patient risk stratification but also offer a more reliable tool for administrative and regulatory uses. Therefore, the development of such a machine learning tool presents a significant opportunity to advance both the science and practice of perioperative care. Incorporating medication use into the algorithm could further enhance its predictive power, as it is closely linked to systemic disease. This addition could help refine the ASA-PS classification, making it an even more valuable tool in the clinical setting.

Study Timeline

• Study Start: 2024-06-25
• Primary Completion: 2024-06-27
• Study Completion: 2024-06-27
• Study First Submitted: 2024-10-01
• Study First Submitted QC: 2024-10-03
• Study First Posted: 2024-10-08
• Status Verified: 2025-05
• Last Update Submitted: 2025-05-14
• Last Update Posted: 2025-05-18

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 149422

Inclusion Criteria

• Underwent a surgical, diagnostic or therapeutic procedure within the surgical suite of the Erasmus MC, and
• ASA-PS score recorded in electronic medical record (EMR), and
• A verified medication list in EMR, or a filled out preoperative anesthesiological health questionnaire registered in EMR

Exclusion Criteria

• Age <18 at moment of surgery, or
• ASA-PS V-VI, or
• Opt-out registered in EMR

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
The American Society of Anesthesiologists physical status (ASA-PS) class	Day 0	The dependent response variable will be the ASA-PS class, both as a four-level variable (ASA-PS I, II, III and IV) and a two-level variable (ASA-PS I and II versus ASA-PS III and IV). The ASA-PS class was assigned to the patient and recorded in the patients file in the EMR by an anesthesiologist of resident anesthesiology as a part of the routinely performed preoperative anesthesiological screening in preparation for a procedure.

Secondary Outcome Measures

Name	Time	Method
Explainability of the prediction model:Local interpretable model-agnostic explanations (LIME)	day 0	Local interpretable model-agnostic explanations (LIME) can offer insights into the contribution of each feature to the prediction of individual instances.
Optimal sample size	day 0	Analysis of the learning curves to determine if additional data would likely improve the model's performance or if the current dataset is sufficient.
Performance metrics: accuracy	day 0	The correct classification of the ASA-PS score will be evaluated using performance metrics of the machine learning algorithms. Common performance metrics include: Accuracy (the proportion of correctly predicted instances).
Performance metrics: precision	day 0	The correct classification of the ASA-PS score will be evaluated using performance metrics of the machine learning algorithms. Common performance metrics include: precision (the ratio of true positive predictions to the total positive predictions)
Performance metrics:recall	day 0	The correct classification of the ASA-PS score will be evaluated using performance metrics of the machine learning algorithms. Common performance metrics include:ecall (sensitivity or the ratio of true positive predictions to the actual positive instances)
Performance metrics: F1-score	day 0	The correct classification of the ASA-PS score will be evaluated using performance metrics of the machine learning algorithms. Common performance metrics include: F1-score (the harmonic mean of precision and recall).
Performance metrics: Area Under the Receiver Operating Characteristic Curve	day 0	The correct classification of the ASA-PS score will be evaluated using performance metrics of the machine learning algorithms. Common performance metrics include:the Area Under the Receiver Operating Characteristic Curve (AUC-ROC, Measures the model's ability to discriminate between positive and negative instances).
Calibration	Day 0	Calibration plots will be used to assess the agreement between predictions and the event rate (i.e. correct classification).
Misclassification of the ASA-PS score	Day 0	A manual review of a selection of misclassifications will be performed by two anesthesiologists to qualitatively assess the cause of the misclassification.
Explainability of the prediction model:Shapley additive explanations (SHAP)	day 0	Shapley additive explanations (SHAP) if applicable, as it can offer insights into the contribution of each feature to the prediction of individual instances.

Trial Locations

Locations (1)

Erasmus MC; 🇳🇱 Rotterdam, Zuid-Holland, Netherlands