ASA Physical Status/ASA Classification
ASA Physical Status Classification
ASA Physical Status Classification
ASA Class:
I
ASA I - Normal Healthy Patient
No organic, physiologic, or psychiatric disturbance. Excludes the very young and very old. Healthy, non-smoking, no or minimal alcohol use.
Classifies health of patients prior to surgery.
When to Use
Used primarily by anesthesiologists as part of the preoperative evaluation of a patient undergoing surgery. Should not be used alone to determine appropriateness of surgery. Other evaluations to be considered prior to surgery may include functional capacity, classification of surgery type, and other chronic conditions.
Formula
Selection of the appropriate description: Description Examples (not comprehensive) ASA Classification Normal healthy patient Healthy, nonsmoker, minimal or no alcohol use ASA 1 Patient with mild systemic disease Mild disease(s) without functional limitations, e.g. current smoker, social alcohol use, pregnant, obesity, well-controlled diabetes or hypertension, mild lung disease ASA 2 Patient with severe systemic disease Substantive functional limitations, ≥1 moderate to severe diseases, e.g. poorly controlled diabetes or hypertension, COPD, morbid obesity, active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderately reduced ejection fraction, ESRD on dialysis, premature infant <60 weeks post-conceptional age, history (>3 months) of MI, CVA/TIA, or CAD/stents ASA 3 Patient with severe systemic disease that is a constant threat to life Recent (within 3 months) MI, CVA/TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severely reduced ejection fraction, sepsis, DIC, ARD, or ESRD not undergoing regularly scheduled dialysis ASA 4 Moribund patient not expected to survive without the operation Ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel with cardiac pathology, or multiple organ/system dysfunction ASA 5 Declared brain-dead patient whose organs are being removed for donor purposes -- ASA 6 Note: for emergency surgery, add suffix E. Emergency = delay would lead to “significant increase in the threat to life or body part”. From American Society of Anesthesiologists (ASA) 2014 .
Advice
A higher grade suggests higher preoperative risk. This score should be used as part of a comprehensive preoperative evaluation. Other factors may play a role in determining the perioperative risk to the patient including type of surgery, other medical conditions, and functional status.