SRS118 - ASA 3 lower limb arthroplasties in purely elective centres without intensive care support: do they pose an additional risk?

Abstract Objective Assess the safety of elective hip and knee replacements in facilities without ITU or on-site medical support by comparing post-operative outcomes complications, ITU needs, and haemoglobin-related results between ASA 3 and ASA 1–2 patients. Methodology A retrospective observational analysis was conducted on prospective data from elective total hip and knee arthroplasties (2023–2024) at Countess of Chester Hospital, using Cerner data. A total of 211 cases were analysed: 118 THR (55.9%) and 93 TKR (44.1%). Analysis was performed using Datatab. Findings Patient distribution: ASA 1 (7.5%, n = 16), ASA 2 (64.2%, n = 136), ASA 3 (27.4%, n = 58), ASA 4 (0.9%, n = 2). Post-operative ITU admissions: 1 ASA 2 patient for cardiac dysrhythmia and 1 ASA 4 patient for acute kidney injury. No statistically significant relationship between ASA classification and post-operative ITU admissions (P = 0.831). Post-operative medical input: No medical team input required during hospital stay. No statistically significant relationship between ASA classification and the need for complex medical care post-operatively (P = 0.932). Mean and median length of stay (LOS): 2.56 and 1.39 days, respectively (Range: 0.46–58.14 days). No statistically significant difference between ASA classification and LOS (P = 0.386). Minor complication: 1 ASA 2 patient had wound oozing. No transfusions or major complications. Conclusions No significant increase in post-operative ITU admissions or medical input was observed between ASA 2 and ASA 3 patients after elective THR and TKR. We suggest ASA 3 patients can safely undergo surgery in low-medical-support settings.