ASA physical status classification system: Is it consistent amongst providers and useful in determining need for pre-operative evaluation resources?

Eakin, John L.; Bader, Angela M.

doi:10.1016/j.jclinane.2017.03.028

Cited by 13 publications

(12 citation statements)

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“…A recent study administered a survey of clinical scenarios to anesthesia providers, surgeons, and internists. In this study, providers of different specialties not only assigned an ASA-PS classification score less consistently, but they also had a tendency to underrate the class of the patients when compared to anesthesia providers given the same scenario (Curatolo et al 2017 ; Eakin and Bader 2017 ).…”

Section: Introductionmentioning

confidence: 71%

Clinical agreement in the American Society of Anesthesiologists physical status classification

2018

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BackgroundThe American Society of Anesthesiologists physical status (ASA-PS) classification is not intended to predict risk, but increasing ASA-PS class has been associated with increased perioperative mortality. The ASA-PS class is being used by many institutions to identify patients that may require further workup or exams preoperatively. Studies regarding the ASA-PS classification system show significant variability in class assignment by anesthesiologists as well as providers of different specialties when provided with short clinical scenarios. Discrepancies in the ASA-PS accuracy have the potential to lead to unnecessary testing and cancelation of surgical procedures. Our study aimed to determine whether these differences in ASA-PS classification were present when actual patients were evaluated rather than previously published scenario-based studies.MethodsA retrospective chart review was completed for patients >/= 65 years of age undergoing elective total hip or total knee replacements. One hundred seventy-seven records were reviewed of which 101 records had the necessary data. The outcome measures noted were the ASA-PS classification assigned by the internal medicine clinic provider, the ASA-PS classification assigned by the Pre-Anesthesia Unit (PAU) clinic provider, and the ASA-PS classification assigned on the day of surgery (DOS) by the anesthesia provider conducting the anesthetic care.ResultsA statistically significant difference was shown between the internal medicine and the PAU preoperative ASA-PS designation as well as between the internal medicine and DOS designation (McNemar p = 0.034 and p = 0.025). Low kappa values were obtained confirming the inter-observer variation in the application of the ASA-PS classification of patients by providers of different specialties [Kappa of 0.170 (− 0.001, 0.340) and 0.156 (− 0.015, 0.327)].ConclusionsThere was disagreement in the ASA-PS class designation between two providers of different specialties when evaluating the same patients with access to full medical records. When the anesthesia-run PAU and the anesthesia assigned DOS ASA-PS class designations were evaluated, there was agreement. This agreement was seen between anesthesia providers regardless of education or training level. The difference in the application of the ASA-PS classification in our study appeared to be reflective of department membership and not reflective of the individual provider’s level of training.

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Section: Introductionmentioning

confidence: 71%

Clinical agreement in the American Society of Anesthesiologists physical status classification

2018

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“…For example, preoperative hospital admission may be necessary for optimization of comorbidities like congestive heart failure; a postoperative admission instead may be indicated to avoid physiologic deterioration or to maintain functional status in the setting of surgical trauma. While observed ASA-PS correlated more strongly with 30-day outcomes than predicted ASA-PS in our study, predicted ASA-PS values could be useful in situations where a pre-populated estimate in an EHR is needed (see Shiny application) or in studies where some or all cases are missing ASA-PS values [33]. Alignment of provider or facility decisions with government or payor guidelines can then be evaluated post-hoc for sample stratification where ASA-PS is missing and for quality monitoring.…”

Section: Discussionmentioning

confidence: 85%

“…The ability to have an electronically-derived measure of ASA-PS can assist with resource allocation and quality measurement as well as care coordination [33]. .…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a predictive model for American Society of Anesthesiologists Physical Status

Mudumbai

Pershing

Bowe

et al. 2019

BMC Health Serv Res

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BackgroundThe American Society of Anesthesiologists Physical Status (ASA-PS) classification system was developed to categorize the fitness of patients before surgery. Increasingly, the ASA-PS has been applied to other uses including justification of inpatient admission. Our objectives were to develop and cross-validate a statistical model for predicting ASA-PS; and 2) assess the concurrent and predictive validity of the model by assessing associations between model-derived ASA-PS, observed ASA-PS, and a diverse set of 30-day outcomes.MethodsUsing the 2014 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data File, we developed and internally cross-validated multinomial regression models to predict ASA-PS using preoperative NSQIP data. Accuracy was assessed with C-Statistics and calibration plots. We assessed both concurrent and predictive validity of model-derived ASA-PS relative to observed ASA-PS and 30-day outcomes. To aid further research and use of the ASA-PS model, we implemented it into an online calculator.ResultsOf the 566,797 elective procedures in the final analytic dataset, 8.9% were ASA-PS 1, 48.9% were ASA-PS 2, 39.1% were ASA-PS 3, and 3.2% were ASA-PS 4. The accuracy of the 21-variable model to predict ASA-PS was C = 0.77 +/− 0.0025. The model-derived ASA-PS had stronger association with key indicators of preoperative status including comorbidities and higher BMI (concurrent validity) compared to observed ASA-PS, but less strong associations with postoperative complications (predictive validity). The online ASA-PS calculator may be accessed at https://s-spire-clintools.shinyapps.io/ASA_PS_Estimator/ConclusionsModel-derived ASA-PS better tracked key indicators of preoperative status compared to observed ASA-PS. The ability to have an electronically derived measure of ASA-PS can potentially be useful in research, quality measurement, and clinical applications.

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“…Inconsistencies in the application of ASA scoring suggest that the system is not easily understood 13 . In a previous study, the ASA score categorized by non‐anaesthesia‐providers is significantly different from anaesthesia‐providers with a 30%‐40% chance of under‐estimating the ASA score 9 .…”

Section: Discussionmentioning

confidence: 94%

Preoperative anaesthesia triage with a patient‐centred system—A prospective clinical study

Molin

Rovsing

Meyhoff

2020

Acta Anaesthesiol Scand

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The increase in day surgery has changed the process of the preoperative anaesthetic evaluation with a need to eliminate unnecessary time and costs without compromising quality and safety of anaesthetic care. 1 The American Society of Anesthesiologists (ASA) score system estimate preoperative health status on a scale from I to VI, 2,3 and the system may guide planning of preoperative evaluation. 4 ASA suggest that for low to moderate complexity surgery, patients with severe systemic disease (ASA score ≥ III) are recommended anaesthetic assessment before the day of surgery, while more healthy subjects (ASA I-II) can be assessed on or before the day of surgery. 5 However, the ASA score system is a subject to high inter-rater variability, 6-9 and does not account for a full patient profile when planning of preoperative intervention. We wanted to develop a Preoperative Patient-Centred Anaesthesia System (Pre-PAS) which aims to streamline triage of patients before preoperative anaesthetic assessment. Pre-PAS is a

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ASA physical status classification system: Is it consistent amongst providers and useful in determining need for pre-operative evaluation resources?

Cited by 13 publications

References 0 publications

Clinical agreement in the American Society of Anesthesiologists physical status classification

Clinical agreement in the American Society of Anesthesiologists physical status classification

Development and validation of a predictive model for American Society of Anesthesiologists Physical Status

Preoperative anaesthesia triage with a patient‐centred system—A prospective clinical study

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