Risk Assessment and Anesthesia Classification in Breast Cancer Surgery

Background: There are various factors affecting the effectiveness of thetreatment of breast cancer patients. Although the disease pathology, along withsurgery and other therapeutic modalities, plays the principal role in patientoutcomes, anesthesia still plays an important role in the success of treatment. Thisstudy was designed to show the effects of anesthetic plans on risk classification andassessment in breast cancer surgeries.Conclusion: The findings of this study support the idea that breast surgeries canbe done in an ambulatory situation with no considerable risk. In contrast, all medicaland anesthetic considerations should be taken into account in more complexsurgeries, especially when they are applied in high-risk patients.Methods: Two hundred sixty patients receiving different types of breast cancersurgery for therapeutic and reconstructive purposes were enrolled in this study.They were divided into three groups according to the anesthesia risk assessment.Group ۱ consisted of low-risk patients (ASA I) who received small surgeries such aslumpectomy. Patients with intermediate risk of anesthesia (ASA II) or those whounderwent breast cancer and axillary surgery with overnight admission (ASA I or II)were considered as group ۲. Group ۳ comprised the patients with higher risk foranesthesia (ASA class III) regardless of the surgery type or those in any ASA classwho were about to undergo advanced and prolonged surgeries such as breastreconstruction with free or pedicle flaps.Results: Two hundred sixty-eight surgical interventions were done in ۲۶۰patients. There were ۱۰۶, ۱۰۷, and ۴۷ patients in groups ۱, ۲, and ۳, respectively. Ingroup ۱, five patients out of ۱۰۶ were admitted in the hospital for ۲۴ hours aftersurgery and the remaining ۱۰۱ patients were discharged from the hospital in a fewhours after the operation when they were fully conscious and could tolerate the dietcompletely. All ۱۰۷ patients in group ۲ were admitted in the hospital for a few daysafter the operation, though the vast majority of them (۹۸ patients) discharged fromthe hospital the day after surgery. In the last group, ۶ out of ۴۷ patients showed thesigns of surgical complications such as partial flap ischemia in the postoperativeperiod, mostly after TRAM or DIEP flap breast reconstruction surgery.

Keywords:

ASA classification , Breast Cancer , Risk Assessment