scholarly journals Evolution of ASA Physical status scoring system

2021 ◽  
Vol 25 (2) ◽  
Author(s):  
Mehreen Malik ◽  
Sana Urooj ◽  
Aftab Imtiaz ◽  
Arif Muhammad Arif
Keyword(s):  
Scoring System ◽  
Risk Index ◽  
Preoperative Evaluation ◽  
Morbidity And Mortality ◽  
Physical Status ◽  
Operative Morbidity ◽  
Hospital Administrators ◽  
Operative Outcomes ◽  
American Society ◽  
American Society Of Anesthesiologists

Anesthesia Preoperative evaluation holds a prime importance in improving overall patient outcomes and decreases hospital expenditure. The American Society of Anesthesiologists Physical Status scoring system ASA-PS was introduced 70 years back in clinical practice and it still holds the lime light for stratifying patient population and considering the risk index and mortality outcomes to warn the surgeon. How has it evolved since the passing years? We will see how over centuries it has evolved. ASA PS has been a significant predictor in depicting morbidity and mortality and evaluating peri-operative risks in patients going for surgery for clinicians, researchers, hospital administrators and government. Further addition of examples of modifying ASA PS status is necessary to make it more comprehensive and easier to use even for non-anesthetists to improve overall peri-operative morbidity and mortality. Key words: ASA PS (American Society of Anesthesiology Physical Status); Peri-operative outcomes Citation: Malik M, Urooj S, Imtiaz A, Arif AM. Evolution of ASA Physical status scoring system. Anaesth. pain intensive care 2021;25(2):225-232. DOI: 10.35975/apic.v25i2.1476 Received: , Reviewed: , Accepted:

scholarly journals The ASA Physical Status Classification: Inter-observer Consistency

2002 ◽  
Vol 30 (5) ◽  
pp. 633-640 ◽  
Author(s):  
P. H. K. Mak ◽  
R. C. H. Campbell ◽  
M. G. Irwin
Keyword(s):  
Classification System ◽  
Physical Disability ◽  
Scoring System ◽  
Physical Status ◽  
Current Pattern ◽  
Physical Status Classification ◽  
Different Types ◽  
Status Classification ◽  
American Society ◽  
American Society Of Anesthesiologists

The American Society of Anesthesiologists (ASA) physical status classification system has previously been shown to be inconsistently applied by anaesthetists. One hundred and sixty questionnaires were sent out to all specialist anaesthetists in Hong Kong. Ten hypothetical patients, identical to those of a similar study undertaken 20 years ago, each with different types and degrees of physical disability were described. Respondents were asked about their country of training and type of anaesthetic practice and to assign an ASA classification status for each patient. Ninety-seven questionnaires were returned (61%) after two mailings. Agreement for each patient within groups, between groups and overall comparisons were made. Percentage of agreement was between 31 to 85%. Overall correlation was only fair in all groups (Kappa indices: 0.21–0.4). We found that the current pattern of inter-observer inconsistency of classification was similar to that 20 years ago and exaggerated between locally and overseas trained specialists (P<0.05). The validity of the ASA system, its usefulness and the need for a new, more precise scoring system is discussed.

scholarly journals Epidural Anaesthesia Saved A Patient With Multiple Co-Morbid Condition

KYAMC Journal ◽  
2017 ◽  
Vol 7 (1) ◽  
pp. 729-730
Author(s):  
Rahena Khatun ◽  
Md Zulfikar Ali
Keyword(s):  
Epidural Anaesthesia ◽  
Postoperative Recovery ◽  
Morbid Condition ◽  
Physical Status ◽  
Uncontrolled Diabetes ◽  
Life Saving ◽  
Diabetic Gangrene ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Morbid Conditions

Epidural anaesthesia has been routinely used for many years and widely accepted as an effective mathod of pain relief . The procedure is commonly performed as a sole anaesthesic or in combination with spinal or general anaesthesia. In our case Md. Alauddin, 59 years old male was admitted in KYAMCH with complaints of diabetic gangrene of right foot with features of septicemia and he has a long history uncontrolled diabetes mellitus and hypertension leading to developed ischemia heart disease and CRF. After proper evaluation patient's physical status was graded as ASA (American society of Anesthesiologists) class-IV, and selected for above knee amputation of right lower limb but patient was unfit for anesthesia due to his co morbid conditions. As a life saving procedure the operation was done under epidural anesthesia and per- operative and postoperative recovery was uneventful.KYAMC Journal Vol. 7, No.-1, Jul 2016, Page 729-730

scholarly journals Discordant American Society of Anesthesiologists Physical Status Scoring between Anesthesiologists and Surgeons Is Correlated With Adverse Patient Outcomes: A Retrospective Cohort Study of 46284 Elective Surgical Patients

2021 ◽  
Author(s):  
Charlene Xian Wen Kwa ◽  
Jiaqian Cui ◽  
Daniel Yan Zheng Lim ◽  
Yilin Eileen Sim ◽  
Yuhe Ke ◽  
...  
Keyword(s):  
Cohort Study ◽  
Patient Outcomes ◽  
Real World ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Clinical Factors ◽  
Physical Status ◽  
Asa Score ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract BackgroundThe American Society of Anesthesiologists Physical Status Classification (ASA) score is used for communication of patient health status, risk scoring, benchmarking and financial claims. Prior studies using hypothetical scenarios have shown poor concordance of ASA scoring among healthcare providers. However, there is a paucity of concordance studies using real-world data, as well as studies of clinical factors or patient outcomes associated with discordant scoring. The study aims to assess real-world ASA score concordance between surgeons and anesthesiologists, factors surrounding discordance and its impact on patient outcomes. MethodsThis retrospective cohort study was conducted in a tertiary academic medical center on 46284 consecutive patients undergoing elective surgery between January 2017 and December 2019. ASA scores entered by surgeons and anesthesiologists, patient demographics, and post-operative outcomes were collected. We assessed the concordance of preoperative ASA scoring between surgeons and anesthesiologists, clinical factors associated with score discordance, the impact of score discordance on clinically important outcomes, and the discriminative ability of the two scores for 30-day mortality, 1-year mortality, and intensive care unit (ICU) admission. Statistical tests used included Cohen’s weighted 𝜅 score, chi-square test, t-test, unadjusted odds ratios and logistic regression models. ResultsThe ASA score showed moderate concordance (weighted Cohen’s 𝜅 0.53) between surgeons and anesthesiologists. 15098 patients (32.6%) had discordant scores, of which 11985 (79.4%) were scored lower by surgeons. We found significant associations between discordant scores and anesthesiologist-assessed comorbidities, patient age and race. Patients with discordant scores had a higher risk of 30-day mortality (odds ratio 2.00, 95% confidence interval [CI] = 1.52-2.62, p<0.0001), 1-year mortality (odds ratio 1.53, 95% CI = 1.38-1.69, p < 0.0001), and ICU admission >24 hours (odds ratio 1.69, 95% CI = 1.47-1.94, p< 0.0001), and stratified analyses showed a trend towards higher risk when the surgeons’ ASA score was lower. ConclusionsThere is moderate concordance between surgeons and anesthesiologists in assigning the ASA classification. Discordant ASA scores are associated with adverse patient outcomes. Hence, there is a need for improved standardization of ASA scoring and cross-specialty review in ASA-discordant cases.

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