Background and Goal of Study: A new scoring system that assesses perioperative patient statuses was developed to predict outcome and severity at the end of anesthesia. The surgical apgar score and the American Society of Anesthesiologists physical status (ASA-PS) were combined into a single scale: SASA. We aimed to determine SASA score and its clinical outcomes in elderly patients undergoing anesthesia.  
Materials and Methods: We conducted an observational prospective study after approval by the ethics committee. Patients aged >60 years, submitted to elective surgery and admitted to Post Anesthesia Care Unit were included. Charlson comorbidity index(CCI) evaluated preoperative morbidity. Clinical Frailty Scale assessed vulnerability before surgery(D0) and 30 days(D30) later: frailty patients were defined as having a score≥5. The Lawton Instrumental Activities of Daily Living Scale and the World Health Organization Disability Assessment Schedule (WHODAS) were evaluated on D0, D30 and 3 months later(M3) to assess dependency and disability. Intraoperative data, including lowest heart rate, mean arterial pressure and estimated blood loss, and ASA-PS were used to calculate SASA. Patients with SASA<13 were considered patients with predicted poor outcome (PPO). The Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) was calculated. The Mann-Whitney test, Chi-square or Fisher’s exact test were used for comparison. 
Results and Discussion: From a total of 235 patients, 32.3% were PPO. These patients were older (p=0.037), more frequently were ASA-PS III/IV (p<0.001) with a higher median score of CCI (8 vs 5 p=0.001). Patients were were frailer at D0 (40% vs. 15% p<0.001) and M3 (47% vs. 22% p<0.001) and more dependent at D0 (p=0.001) and M3 (p=0.001), with higher median scores on WHODAS at D0 (29 vs. 8 p<0.001) and D30 (31 vs.17 p<0.001). Intraoperatively, they needed more frequently colloids infusion (9,3% vs. 3% p=0.028) and blood transfusions (8 %vs. 1% p=0.014). According to POSSUM, these patients had higher risks of morbidity (46% vs 34% p<0.001) and mortality (13% vs. 9% p<0.001). They had a longer hospital stay (8 vs. 4 days p<0.001), higher mortality (8% vs. 2% p=0.034) and rate of reoperation at M3 (19% vs 7% p=0.005). 
Conclusions: In our study, SASA score<13 had shown to be useful to identify dependent and frail patients having more comorbidities and blood transfusion needs. It was also related with higher hospital stay, mortality and reoperation rate in elderly patients.

01 / A predicting severity surgical scoring system and outcome in elderly patients undergoing anesthesia