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.
The Evolution, Current Value, and Future of the American Society of Anesthesiologists Physical Status Classification System
This article is featured in “This Month in Anesthesiology,” page A1.
B.H. and B.K. contributed equally to this article.
Submitted for publication December 2, 2020. Accepted for publication July 21, 2021. Published online first on September 7, 2021.
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Balazs Horvath, Benjamin Kloesel, Michael M. Todd, Daniel J. Cole, Richard C. Prielipp; The Evolution, Current Value, and Future of the American Society of Anesthesiologists Physical Status Classification System. Anesthesiology 2021; 135:904–919 doi: https://doi.org/10.1097/ALN.0000000000003947
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