American Society of Anaesthesiologists physical status classification

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Abstract

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.

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Most cited references 27

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Infection of the surgical site after arthroplasty of the hip.

S Ridgeway, J Wilson, A Charlet … (2005)

We wished to estimate the incidence of surgical-site infection (SSI) after total hip replacement (THR) and hemiarthroplasty and its strength of association with major risk factors. The SSI surveillance service prospectively gathered clinical, operative and infection data on inpatients from 102 hospitals in England during a four-year period. The overall incidence of SSI was 2.23% for 16,291 THRs, 4.97% for 5769 hemiarthroplasty procedures, 3.68% for 2550 revision THRs and 7.6% for 198 revision hemiarthroplasties. Staphylococcus aureus was identified in 50% of SSIs; 59% of these isolates were methicillin-resistant (MRSA). In the single variable analysis of THRs, age, female gender, American Society of Anesthesiologists (ASA) score, body mass index, trauma, duration of operation and pre-operative stay were significantly associated with the risk of SSI (p < 0.05). For hemiarthroplasty, the ASA score and age were significant factors. In revision THRs male gender, ASA score, trauma, wound class, duration of operation and pre-operative stay were significant risk factors. The median time to detection of SSI was eight days for superficial incisional, 11 days for deep incisional and 11 days for joint/bone infections. For each procedure the mean length of stay doubled for patients with SSI. The multivariate analysis identified age group, trauma, duration of operation and ASA score as significant, independent risk factors for SSI. There was significant interhospital variation in the rates of SSI. MRSA was the most common pathogen to cause SSI in hip arthroplasty, especially in patients undergoing hemiarthroplasty, but coagulase-negative Staph. aureus may be more important in deep infections involving the joint.

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Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients.

C. Wang, Hilary Hsu, C Changchien … (2001)

To identify the risk factors for surgical site infection (SSI) in patients undergoing elective resection of the colon and rectum. SSI causes a substantial number of deaths and complications. Determining risk factors for SSI may provide information on reducing complications and improving outcome. The authors performed a prospective study of 2,809 consecutive patients undergoing elective colorectal resection via laparotomy between February 1995 and December 1998 at a single institution. The outcome of interest was SSI, which was classified as being incisional or organ/space with or without clinical leakage. A likelihood ratio forward regression model was used to assess the independent association of variables with SSIs. The overall SSI, incisional SSI, and organ/space SSI with and without clinical anastomotic leakage rates were 4.7%, 3%, 2%, and 0.8%, respectively. Risk factors for overall SSI were American Society of Anesthesiology (ASA) score 2 or 3 (odd ratio [OR] = 1.7), male gender (OR = 1.5), surgeons (OR = 1.3-3.3), types of operation (OR = 0.3-2.1), creation of ostomy (OR = 2.1), contaminated wound (OR = 2.9), use of drainage (OR = 1.6), and intra- or postoperative blood transfusion (1-3 units, OR = 5.3; >/=4 units, OR = 6.2). However, SSIs at specific sites differed from each other with respect to the risk factors. Among a variety of risk factors, only blood transfusion was consistently associated with a risk of SSI at any specific site. In addition to ASA score and surgical wound class, blood transfusion, creation of ostomy, types of operation, use of drainage, sex, and surgeons were important in predicting SSIs after elective colorectal resection.

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ASA classification and perioperative variables as predictors of postoperative outcome.

T. Wolf, Torsten Schröder, U Wolters … (1996)

In a prospective study of 6301 surgical patients in a university hospital, we examined the strength of association between ASA physical status classification and perioperative risk factors, and postoperative outcome, using both univariate analysis and calculation of the odds ratio of the risk of developing a postoperative complication by means of a logistic regression model. Univariate analysis showed a significant correlation (P < 0.05) between ASA class and perioperative variables (intraoperative blood loss, duration of postoperative ventilation and duration of intensive care stay), postoperative complications and mortality rate. Univariate analysis of individual preoperative risk factors demonstrated their importance in the development of postoperative complications in the related organ systems. Estimating the increased risk odds ratio for single variables, we found that the risk of complication was influenced mainly by ASA class IV (risk odds ratio = 4.2) and ASA class III (risk odds ratio = 2.2). We conclude that ASA physical status classification was a predictor of postoperative outcome.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Anaesth

Journal ID (publisher-id): IJA

Title: Indian Journal of Anaesthesia

Publisher: Medknow Publications (India )

ISSN (Print): 0019-5049

ISSN (Electronic): 0976-2817

Publication date (Print): Mar-Apr 2011

Volume: 55

Issue: 2

Pages: 111-115

Affiliations

Department of Anaesthesia, Riyadh Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia

Author notes

Address for correspondence: Dr. Mohamed Daabiss, Department of Anaesthesia, Riyadh Armed Forces Hospital, P.O. Box 7897-D186 Riyadh 11159, Kingdom of Saudi Arabia. E-mail: madaabiss@ 123456yahoo.com

Article

Publisher ID: IJA-55-111

DOI: 10.4103/0019-5049.79879

PMC ID: 3106380

PubMed ID: 21712864

SO-VID: 5485128f-e60b-442e-8abc-ddfe05493f9e

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

American Society of Anaesthesiologists physical status classification

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Cardiovascular Innovations and Applications

Most cited references 27

Infection of the surgical site after arthroplasty of the hip.

Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients.

ASA classification and perioperative variables as predictors of postoperative outcome.

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