The ACPGBI/NBOCA recommend that ASA grade of each patient must be determined by the anaesthetist alone before resection of the cancer. The anaesthetist commonly gives this judgement as part of the “Time Out” – before the surgical procedure starts. The Colorectal Surgeon should record the ASA grade given by the anaesthetist in the operation note and this will be the grade submitted to NBOCA.
At no point should the Colorectal Surgeon determine the ASA grade of the patient undergoing resection. This is because this grade will be used in the risk adjustment of that clinician’s 90-day mortality in the Clinical Outcomes Publication.
ASA grade is a central component of NBOCA risk-adjustment. Feedback from some MDTs has indicated that the diagnosis of colorectal cancer alone has been used routinely to justify ASA II – despite the fact that the large majority of colorectal cancer patients have localised disease at the time of resection and not systemic disease.