The American Society of Anesthesiologists' class as a comorbidity index in a cohort of head and neck cancer surgical patients

Head Neck. 2001 Nov;23(11):985-94. doi: 10.1002/hed.1143.


Background: We assessed the American Society of Anesthesiologists' (ASA) class, as a measure of comorbidity in comparison to the commonly used Charlson index for prognostic ability in a HNCA population.

Methods: Proportional hazards methods were applied to head and neck cancer patients whose treatment included surgery by the Johns Hopkins Otolaryngology service (n = 388).

Results: The Charlson index and ASA class were modestly correlated (Spearman 0.36, p <.001). Compared with patients with ASA class 1 or 2, those with ASA class 3 or 4 had a two-fold elevated mortality rate (Relative Hazard (RH) = 2.00, 95% CI, 1.38-2.89). This association was stronger than observed for a Charlson index score of 1 or more compared with 0 (RH = 1.59, 95% CI, 1.17-2.17). Both the Charlson index and ASA class adjusted RHs displayed dose-response patterns (p value for trend <.001).

Conclusions: Compared with the Charlson index, the ASA class had comparable if not greater prognostic ability for mortality in this elderly HNCA population.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Comorbidity
  • Female
  • Head and Neck Neoplasms / classification*
  • Head and Neck Neoplasms / mortality*
  • Humans
  • Male
  • Prognosis
  • Proportional Hazards Models
  • Survival Analysis