The Evolution, Current Value, and Future of the American Society of Anesthesiologists Physical Status Classification System

Balazs Horvath; Benjamin Kloesel; Michael M Todd; Daniel J Cole; Richard C Prielipp

doi:10.1097/ALN.0000000000003947

The Evolution, Current Value, and Future of the American Society of Anesthesiologists Physical Status Classification System

Anesthesiology. 2021 Nov 1;135(5):904-919. doi: 10.1097/ALN.0000000000003947.

Authors

Balazs Horvath¹, Benjamin Kloesel¹, Michael M Todd¹, Daniel J Cole², Richard C Prielipp¹

Affiliations

¹ From the Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota.
² Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California.

PMID: 34491303
DOI: 10.1097/ALN.0000000000003947

Abstract

The American Society of Anesthesiologists (ASA) Physical Status classification system celebrates its 80th anniversary in 2021. Its simplicity represents its greatest strength as well as a limitation in a world of comprehensive multisystem tools. It was developed for statistical purposes and not as a surgical risk predictor. However, since it correlates well with multiple outcomes, it is widely used-appropriately or not-for risk prediction and many other purposes. It is timely to review the history and development of the system. The authors describe the controversies surrounding the ASA Physical Status classification, including the problems of interrater reliability and its limitations as a risk predictor. Last, the authors reflect on the current status and potential future of the ASA Physical Status system.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Anesthesiologists
Anesthesiology / methods*
Health Status Indicators*
Health Status*
Humans
Postoperative Complications / prevention & control*
Reproducibility of Results
Risk Assessment
Societies, Medical
United States