American Society of Anesthesiologists Classification

Excerpt

The American Society of Anesthesiologists (ASA) physical status classification system came about to offer perioperative clinicians a simple categorization of a patient's physiological status to help predict operative risk. The ASAPS originated in 1941 and has seen some revisions since that time. Unfortunately, while the ordinal classification scheme is simple, it is far from an ideal preoperative measure for assessment. Once properly reviewed, the differences that might separate any given patient from being classified in any ASAPS classification category from another patient in either a higher or lower category may be extreme from one healthcare provider, group, or system compared to another. While its utility as a simple classification is perhaps its best feature, this also portends its serious deficiencies. There is certainly a considerable body of evidence correlating ASAPS classification with a variety of useful outcomes.

As it was neither developed nor intended to be used to predict risk with anesthesia or surgery, it is difficult to utilize it in the individual management of any patient beyond very general concepts. More concerning are the great number of areas, purposes, healthcare providers, and guidelines/standards that attempt to utilize the ASAPS for an increasing plethora of purposes for which it was never intended, which will only invariably lead to a host of unintended and potentially negative consequences. This is punctuated even more so when one considers the tremendous variability and inconsistency in the classification of any one patient among non-anesthesiologists as well as even among anesthesiologists, not to mention the variability and inconsistency between anesthesiologists versus non-anesthesiologists.