Purpose/Objectives:

The purpose of the study was to answer these research questions: is the ASA class related to postoperative complications? Is the ASA class related to increased length of stay?

Significance:

There are economic effects based on third-party payer's reimbursement to hospitals. These occur at preset rates without consideration given to patients' ASA classifications and/or comorbidities preoperatively.

Design/Background/Rationale:

The study included English-speaking patients aged 65 years or older who were scheduled for major noncardiac surgery requiring anesthesia and who were expected to remain in the hospital postoperatively for at least 48 hours. Excluded from the study were patients who did not provide or were incapable of providing written informed consent. A total of 530 patients were observed.

Methods/Description:

The dependent variable was any postoperative complication: acute infection, renal complication, pulmonary complication, cardiac complication, or unexpected admission to the intensive care unit. Independent variables included age, sex, race, and type of surgery (orthopedic/neurological; gynecological/urological; vascular/thoracic; general; plastic; or ear, nose, and throat). Covariates included ASA classification, Charlson comorbidity score, and the number of dependencies patients had preoperatively based on their ability to perform activities of daily living.

Findings/Outcomes:

Patients with an ASA class of 3 or 4 are 78% more likely to have a postoperative complication than patients with an ASA class of 1 or 2. Patients who are 80 years or older are 75% more likely to experience a postoperative complication than patients who are less than 80 years old. Males are more likely to experience a postoperative complication than females. Patients who have renal disease preoperatively are 2.5 times more likely to experience postoperative complications.

Conclusions:

Male patients who are 80 years or older with a history of renal disease are 2.5 times more likely to experience a postoperative complication if they are an ASA class 3 or 4.

Implications for Practice:

Health policy should be adapted to influence third-party payers to adjust to the increased length of stays and economic effects of patients who are ASA 3 or 4 with a history of preoperative renal disease.

Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.

Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.

The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.