Variability in the American Society of Anesthesiologists (ASA) Physical Status (PS) Classifcation Scale (original) (raw)
Related papers
Annals of Surgery, 2006
The purpose of this study was to determine the relationship between the American Society of Anesthesiologists' Physical Status (ASA PS) classifications and the other National Surgical Quality Improvement Program (NSQIP) preoperative risk factors. Background: The ASA PS has been shown to predict morbidity and mortality in surgical patients but is inconsistently applied and clinically imprecise. It is desirable to have a method for validating ASA PS classification levels. Methods: The NSQIP preoperative risk factors, including ASA PS, were recorded from a random sample of 5878 surgical patients on 6 services between October 1, 2001 and September 30, 2003 at the University of Kentucky Medical Center. Mortality, morbidity, costs, and length of stay were obtained and compared across ASA PS levels. The ability of 1) ASA PS alone, 2) the other NSQIP risk factors, and, 3) all factors combined to predict outcomes was analyzed. A model using the other NSQIP risk factors was developed to predict ASA PS. Results: ASA PS alone was a strong predictor of outcomes (P Ͻ 0.01). However, the other NSQIP risk factors were better predictors as a group. There was significant interdependence between the ASA PS and the other NSQIP risk factors. Predictions of ASA PS using the other factors showed strong agreement with the anesthesiologists' assignments. Conclusions: The NSQIP risk factors other than ASA PS can and should be used to validate ASA PS classifications.
BMC medical informatics and decision making, 2016
The American Society of Anesthesiologists Physical Status classification (ASA PS) of surgical patients is a standard element of the preoperative assessment. In early 2013, the Department of Anesthesia was notified that the distribution of ASA PS scores for sampled patients at the University of Iowa had recently begun to deviate from national comparison data. This change appeared to coincide with the transition from paper records to a new electronic Anesthesia Information Management System (AIMS). We hypothesized that the design of the AIMS was unintentionally influencing how providers assigned ASA PS values. Primary analyses were based on 12-month blocks of data from paper records and AIMS. For the purpose of analysis, ASA PS was dichotomized to ASA PS 1 and 2 vs. ASA PS >2. To ensure that changes in ASA PS were not due to "real" changes in our patient mix, we examined other relevant covariates (e.g. age, weight, case distribution across surgical services, emergency vs....
Develop a validated anesthesia quality assessment to evaluate patients postoperatively
Journal of Anesthesia & Critical Care: Open Access, 2020
Objective: The study is aimed to develop a well-validated anesthesia quality assessment to evaluate patients postoperatively. Materials and Methods: After securing Institutional Review Board approval, the study was registered via ClinicalTrials.gov (NCT 0307996). The Siriraj Anesthesia Quality Assessment Questionnaire was developed and validated under the conceptual/theoretical framework of Maslow's hierarchy of needs, Hospital Consumer Assessment of Healthcare Providers and System, Patient Satisfaction Questionnaire, Service Quality Questionnaire and Quality of Recover after Anesthesia. A total of 476 qualified responses with obtained consent were included in the study to verify the appropriateness of the tool. Results: The study involved 397 qualified patients (83.4%), aged 47.6±16.6, representing all anesthesia services. Significantly, a binary logistic regression revealed the predicted dependent variables as Process of Care (4.39±0.51) and Physical Support (4.35±0.66) in comparison with a sequence of Accessibility and Convenience (4.33±0.56), Communication and Information (4.00±0.70), Technical Quality (4.46±0.45) Psychological Support (4.57±0.65) and Loyalty (4.52±0.68) in anesthesia quality assessment. Conclusion: Process of Care and Physical Support appeared to be significantly valued features, whereas Communication and Information, Accessibility and Convenience, Technical Quality and Psychological Support were found to be weak points in anesthesia quality assessment.
Pediatric Anesthesia, 2007
The scope and application of the American Society of Anesthesiologists Physical Status (ASA PS) classification has been called into question and interobserver consistency even by specialist anesthesiologists has been described as only fair. Our purpose was to evaluate the consistency of the application of the ASA PS amongst a group of pediatric anesthesiologists. Methods: We randomly selected 400 names from the active list of specialist members of the Society for Pediatric Anesthesia. Respondents were asked to rate 10 hypothetical pediatric patients and answer four demographic questions. Results: We received 267 surveys, yielding a response rate of 66.8% and the highest number of responses in any study of this nature. The spread of answers was wide across almost all cases. Only one case had a response spread of only two classifications, with the remaining cases having three or more different ASA PS classifications chosen. The most variability was found for a hypothetical patient with severe trauma, who received five different ASA PS classifications. The Modified Kappa Statistic was 0.5, suggesting moderate agreement. No significant difference between the private and academic anesthesiologists was found (P = 0.26). Conclusions: We present the largest evaluation of interobserver consistency in ASA PS in pediatric patients by pediatric anesthesiologists. We conclude that agreement between anesthesiologists is only moderate and suggest standardizing assessment, so that it reflects the patient status at the time of anesthesia, including any acute medical or surgical conditions.
Anesthesiology, 2001
To the Editor:-I read with interest the recent article by Ripart et al. 1 about ophthalmic regional anesthesia for cataract surgery. The authors stated, 'Cataract surgery requires a potent motor blockade (akinesia) of the eyeball and eyelids.' However, this statement is contradicted by the fact that excellent operating conditions can be obtained by using topical anesthesia with or without sedation. 2,3 Moreover, the topical technique avoids the rare but severe complications that may occur with injection anesthesia for ophthalmic surgery, such as perforation of the globe, retrobulbar hemorrhage, and dural or intravascular injection of local anesthetics. 4-5 The use of topical anesthesia for cataract surgery increased to more than 37% of cases in 1998. 6 At my facility, an increasing portion of the cases is treated with use of topical anesthesia, and the advantages in comparison with regional or injection anesthesia are dramatic.
American Society of Anaesthesiologists physical status classification
Indian Journal of Anaesthesia, 2011
Although the American Society of Anaesthesiologists' (ASA) classification of Physical Health is a widely used grading system for preoperative health of the surgical patients, multiple variations were observed between individual anaesthetist's assessments when describing common clinical problems. This article reviews the current knowledge and evaluation regarding ASA Classification of Physical Health as well as trials for possible modification.
2018
Background: The American Society of Anaesthesiologists-Physical Status (ASA-PS) Classification is a grading system for classifying surgical patients based on their comorbid background. Despite numerous benefits, its highly subjective nature has led to marked inconsistency when used. The purpose of this study was to assess consistency when public sector anaesthetists score trauma and non-trauma surgical patients using the Classification.Methods: A three-part questionnaire, with 18 clinical scenarios, was administered to 98 anaesthetists requiring them to grade the scenarios using the Classification and give their opinion on its usage.Results: We received 97 completed questionnaires. Eighty-eight percent of respondents routinely use the Classification. Fifty-two percent had read the Classification within the last six months. Many limitations of the use of the ASA System were identified. There was a lack of consistency in the scoring of the scenarios, with each scenario receiving at le...
Medicina
Background and Objectives: Numerous scoring systems have been introduced into modern medicine. None of the scoring systems assessed both anesthetic and surgical risk of the patient, predict the morbidity, mortality, or the need for postoperative intensive care unit admission. The aim of this study was to compare the anesthetic and surgical scores currently used, for a better evaluation of perioperative risks, morbidity, and mortality. Material and Methods: This is a pilot, prospective, observational study. We enrolled 50 patients scheduled for elective surgery. Anesthetic and surgery risk was assessed using American Society of Anesthesiologists (ASA) scale, Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM), Acute Physiology and Chronic Health Evaluation (APACHE II), and Surgical APGAR Score (SAS) scores. The real and the estimated length of stay (LOS) were registered. Results: We obtained several statistically significant positive c...