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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
Daniel John Doyle ; Joseph Maxwell Hendrix ; Emily H. Garmon .
Last Update: August 17, 2023 .
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 that can help predict operative risk. The ASAPS originated in 1941 and has seen some revisions since that time. This activity covers the American Society of Anesthesiologists (ASA) physical status classification system's classification of patients so healthcare teams can make informed decisions as to some meaningful correlated outcomes. This activity describes the current understanding regarding the application or misapplication of the ASAPS. This activity illustrates the relevant considerations and controversies regarding the ASAPS. This activity reviews the evaluation and application of the ASAPS and highlights the role of the interprofessional team in evaluating and treating patients while utilizing this classification system.
Identify the included factors and their limitations that influence the American Society of Anesthesiologists (ASA) physical status classification system.
Review the issues of concern and controversy surrounding the American Society of Anesthesiologists (ASA) physical status classification system.
Summarize each category within the American Society of Anesthesiologists (ASA) physical status classification system.
Outline and explain interprofessional team strategies for improving care coordination and communication using the American Society of Anesthesiologists (ASA) physical status classification system to facilitate the management of patients in the perioperative period.
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.[1][2][3] 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.[4] 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.[5] 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.[6][5][4]
Perioperative staff could utilize this classification system for perioperative outcomes management. However, this must be considered in the larger context of the variability and inconsistency with classification between classifying entities, as meta-analyses have shown the ASAPS having a sensitivity around 0.74 (95% confidence intervals 0.73 to 0.74), specificity around 0.67 (0.67 to 0.67), and a receiver operating curve area under the summary of around 0.736 (0.725 to 0.747) in predicting mortality postoperatively.[7][8] For robust and reliable preoperative risk assessment, one needs to consider a variety of additional factors discretely in addition to the information provided by a composite index classification:[6]
