Perioperative medicine & outcomes
Development of the Anesthesia Risk Assessment Score (ARAS) for postoperative mortality and adverse discharge to a nursing facility
Authors' conclusion
Six clinical questions that can be obtained directly from patients predict postoperative mortality and adverse discharge. The predictive accuracy is comparable to the ASA-PS, RCRI, and mFI-5 scores, with the advantage of being able to be used early in the preoperative evaluation triage process prior to clinician input.
Study context
- Population
- Adults undergoing non-ambulatory surgery, Montefiore Medical Center (Bronx, NY), January 2016–February 2023developmental cohort
- Participants
- 59,099 adults
- Comparison
- ARAS vs ASA-PS, ML-ASA, RCRI and mFI-5
- Outcome
- Mortality within 30 days of surgery (discrimination, ROC-AUC)
- Follow-up
- 30 days
Methodological detailsretrospective, single-centre, stepwise backwards elimination, internal validation in an independent cohort
- Retrospective
- Single-centre
- Stepwise backwards elimination
- Internal validation in an independent cohort
Performance
As reported in the abstract
30-day postoperative mortality (AUC)
| Test or model | AUC |
|---|---|
| ARAS | 0.82 |
| ASA-PS | 0.78 |
| ML-ASA | 0.79 |
| RCRI | 0.76 |
| mFI-5 | 0.72 |
AUC
ARAS0.82
ASA-PS0.78
ML-ASA0.79
RCRI0.76
mFI-50.72
- ARAS superior to each comparator score
- P < 0.001
- Deaths within 30 days in developmental cohort
- 891 (1.53 %)
Further findings
| Outcome | Values |
|---|---|
| Adverse (non-home) discharge, discrimination | ARAS AUC 0.76 |
- Adverse (non-home) discharge, discrimination: 5013 (9.1 %) adversely discharged in developmental cohort
- Adverse (non-home) discharge, discrimination: p < 0.001
Adverse (non-home) discharge, discrimination
- AUC of the comparator scores, printed as "vs 0.70, 0.74, 0.65, 0.73; p < 0.001, respectively"; ARAS performance similar to that for mortality
Internal validation cohort
- Results remained robust in the validation cohort (n = 13,137)
Original publication
Development of the Anesthesia Risk Assessment Score (ARAS) for postoperative mortality and adverse discharge to a nursing facility. J Clin Anesth. Published 30 June 2025. doi:10.
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