Development of the Anesthesia Risk Assessment Score (ARAS) for postoperative mortality and adverse discharge to a nursing facility

Rafi Khandaker; Karuna Wongtangman; Marcus Frank; Felix Borngaesser; Richard V. Smith; Linda Nie; Shweta Garg; Bilal Tufail; Jeffrey Freda; Preeti Anand; Adela Aguirre-Alarcon; Matthias Eikermann; Carina P. Himes

doi:10.1016/j.jclinane.2025.111918

journal article Sep 01, 2025

Development of the Anesthesia Risk Assessment Score (ARAS) for postoperative mortality and adverse discharge to a nursing facility

Rafi Khandaker Karuna Wongtangman Marcus Frank Felix Borngaesser Richard V. Smith Linda Nie Shweta Garg Bilal Tufail Jeffrey Freda Preeti Anand Adela Aguirre-Alarcon Matthias Eikermann Carina P. Himes

Journal of Clinical Anesthesia Vol. 106 pp. 111918 · Elsevier BV

View at Publisher Save 10.1016/j.jclinane.2025.111918

Topics

No keywords indexed for this article. Browse by subject →

References

86

[1]

Doyle (2023)

[2]

Hocevar (2023)

[3]

Hackett "ASA class is a reliable independent predictor of medical complications and mortality following surgery" Int J Surg (2015) 10.1016/j.ijsu.2015.04.079

[4]

Hopkins "Associations between ASA Physical Status and postoperative mortality at 48 h: a contemporary dataset analysis compared to a historical cohort" Perioper Med (2016)

[5]

Wolters "ASA classification and perioperative variables as predictors of postoperative outcome" Br J Anaesth (1996) 10.1093/bja/77.2.217

[6]

Aronson "Variability in the American Society of Anesthesiologists Physical Status Classification Scale" AANA J (2003)

[7]

Kayla Knuf "Addressing inter-rater variability in the ASA-PS classification system" Mil Med (2020) 10.1093/milmed/usz433

[8]

Kwa "Discordant American Society of Anesthesiologists Physical Status Classification between anesthesiologists and surgeons and its correlation with adverse patient outcomes" Sci Rep (2022) 10.1038/s41598-022-10736-5

[9]

Wongtangman "Development and validation of a machine learning ASA-score to identify candidates for comprehensive preoperative screening and risk stratification" J Clin Anesth (2023) 10.1016/j.jclinane.2023.111103

[10]

Bilimoria "Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aide and informed consent tool for patients and surgeons" J Am Coll Surg (2013) 10.1016/j.jamcollsurg.2013.07.385

[11]

Weaver "The modified 5-item frailty index: a concise and useful tool for assessing the impact of frailty on postoperative morbidity following elective posterior lumbar fusions" World Neurosurg (2019)

[12]

Goldman "Multifactorial index of cardiac risk in noncardiac surgical procedures" N Engl J Med (1977) 10.1056/nejm197710202971601

[13]

Gupta "Development and validation of a risk calculator for prediction of cardiac risk after surgery" Circulation (2011) 10.1161/circulationaha.110.015701

[14]

Gosling "Development of an instrument for preoperative prediction of adverse discharge in patients scheduled for cardiac surgery" J Cardiothorac Vasc Anesth (2021)

[15]

Schaefer "What factors predict adverse discharge disposition in patients older than 60 years undergoing lower-extremity surgery? The adverse discharge in older patients after lower-extremity surgery (ADELES) risk score" Clin Orthop Relat Res (2021)

[16]

Witt "Hispanic/Latino ethnicity and loss of post-surgery independent living: a retrospective cohort study from a Bronx hospital network" Anesth Analg (2024) 10.1213/ane.0000000000006948

[17]

Edwards "The metabolic equivalent of task score : a useful metric for comparing high-functioning hip arthroplasty patients" Bone Joint Res (2022)

[18]

Wongtangman "Incidence and predictors of case cancellation within 24 h in patients scheduled for elective surgical procedures" J Clin Anesth (2022)

[19]

Agency for Healthcare Research and Quality (2009)

[20]

Thompson "AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline for perioperative cardiovascular management for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice guidelines" Circulation (2024)

[21]

Lurati Buse "Association between self-reported functional capacity and major adverse cardiac events in patients at elevated risk undergoing noncardiac surgery: a prospective diagnostic cohort study" Br J Anaesth (2021)

[22]

Kokkinos "Exercise capacity and mortality in older men: a 20-year follow-up study" Circulation (2010)

[23]

Gulati "Exercise capacity and the risk of death in women: the St. James Women Take Heart Project" Circulation (2003)

[24]

Myers "Exercise capacity and mortality among men referred for exercise testing" N Engl J Med (2002)

[25]

Zhao "Association between frailty and clinical outcomes and quality of life in older adults following hip fracture surgery: a retrospective cohort study" Anesth Analg (2022)

[26]

Gong "Association between the FRAIL scale and postoperative complications in older surgical patients: a systematic review and meta-analysis" Anesth Analg (2023)

[27]

Shah "Association of frailty with failure to rescue after low-risk and high-risk inpatient surgery" JAMA Surg (2018)

[28]

McIsaac "Frailty as a predictor of death or new disability after surgery: a prospective cohort study" Ann Surg (2020)

[29]

Seib "Association of patient frailty with increased morbidity after common ambulatory general surgery operations" JAMA Surg (2018)

[30]

Bronheim "Coagulation profile as a risk factor for 30-day morbidity and mortality following posterior lumbar fusion" Spine (Phila Pa 1976) (2017) 10.1097/brs.0000000000001935

[31]

Glance "Preoperative thrombocytopenia and postoperative outcomes after noncardiac surgery" Anesthesiology (2014) 10.1097/aln.0b013e3182a4441f

[32]

Jørgensen "Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery" JAMA (2014) 10.1001/jama.2014.8165

[33]

Christiansen "Risks of cardiovascular adverse events and death in patients with previous stroke undergoing emergency noncardiac, nonintracranial surgerythe importance of operative timing" Anesthesiology (2017) 10.1097/aln.0000000000001685

[34]

Liao "Outcomes after surgery in patients with previous stroke" Br J Surg (2014) 10.1002/bjs.9639

[35]

Tsoris (2019)

[36]

von Brauchitsch "High end-of-life incidence of seizures and status epilepticus in patients with primary and secondary brain tumors" J Neurooncol (2022) 10.1007/s11060-022-04133-1

[37]

Huff (2023)

[38]

Seo "Pharmacological treatment of epilepsy in elderly patients" J Clin Neurol (2020) 10.3988/jcn.2020.16.4.556

[39]

Goldstone "Predictors and outcomes of seizures after cardiac surgery: a multivariable analysis of 2,578 patients" Ann Thorac Surg (2011)

[40]

Lerman "Association of left ventricular ejection fraction and symptoms with mortality after elective noncardiac surgery among patients with heart failure" JAMA (2019) 10.1001/jama.2019.0156

[41]

Lerman "Association between heart failure and postoperative mortality among patients undergoing ambulatory noncardiac surgery" JAMA Surg (2019) 10.1001/jamasurg.2019.2110

[42]

Glaser "Long-term outcomes associated with permanent pacemaker implantation after surgical aortic valve replacement" JAMA Netw Open (2021) 10.1001/jamanetworkopen.2021.16564

[43]

Greason "Long-term mortality effect of early pacemaker implantation after surgical aortic valve replacement" Ann Thorac Surg (2017) 10.1016/j.athoracsur.2017.01.083

[44]

Carrington "It is possible to predict mortality after ICD implantation?" Eur Heart J (2021)

[45]

Pyatt "Long-term survival after permanent pacemaker implantation: analysis of predictors for increased mortality" EP Europace (2002) 10.1053/eupc.2002.0233

[46]

Marini "Pacemaker therapy in very elderly patients: survival and prognostic parameters of single center experience" J Geriatr Cardiol (2019)

[47]

Liao "Long-term outcome in patients receiving permanent pacemaker implantation for atrioventricular block comparison of VDD and DDD pacing" Medicine (United States) (2016)

[48]

Abbitt "Preoperative risk factors for discharge to facility after surgery in geriatric patients" Am Surg (2024) 10.1177/00031348241256056

[49]

Legner "Risk factors for nursing home placement following major nonemergent surgery" Am J Med (2004)

[50]

Hung "Preoperative functional status is associated with discharge to nonhome in geriatric individuals" J Am Geriatr Soc (2021)

Showing 50 of 86 references

Metrics

1

Citations

86

References

Details

Published: Sep 01, 2025
Vol/Issue: 106
Pages: 111918
License: View

Authors

Adela Aguirre-Alarcon

Cite This Article

Rafi Khandaker, Karuna Wongtangman, Marcus Frank, et al. (2025). Development of the Anesthesia Risk Assessment Score (ARAS) for postoperative mortality and adverse discharge to a nursing facility. Journal of Clinical Anesthesia, 106, 111918. https://doi.org/10.1016/j.jclinane.2025.111918

Development of the Anesthesia Risk Assessment Score (ARAS) for postoperative mortality and adverse discharge to a nursing facility

You May Also Like