Digestive Health Associates

Southwest Endoscopy Center

ASA Classification


The classification and common modifications and examples used to assist in patient classification are shown.  Modifications and examples have been widely published but have not been adopted or accepted by the ASA. 

Studies of interrater reliability in both the adult and pediatric literature show a high degree of variability (high inter-observer inconsistency), which limits the validity and usefulness of the classification for clinical and regulatory purposes.

See PubMed literature search
describing inter-observer variability.
See Wikipedia:  ASA physical status classification system

American Society of Anesthesiologists

www.asahq.org accessed January 4, 2009
 
P1 A normal healthy patient
   
P2 A patient with mild systemic disease
   
P3 A patient with severe systemic disease
   
P4 A patient with severe systemic disease that is a constant threat to life
   
P5 A moribund patient who is not expected to survive without the operation
   
P6 A declared brain-dead patient whose organs are being removed for donor purposes

These definitions appear in each annual edition of the ASA Relative Value Guide.  There is no additional information that will help you further define these categories.


AGA Institute Review of Endoscopic Sedation

Cohen LB, DeLegge MH, Aisenberg JA et al.  Gastroenterology 2007;133:675-701


ASA Classification

ClassDescription
I The patient is normal and healthy
II The patient has mild systemic disease that does not limit their activities (eg, controlled hypertension or controlled diabetes without systemic sequelae)
III The patient has moderate or severe systemic disease, which does limit their activities (eg, stable angina or diabetes with systemic sequelae)
IV The patient has severe systemic disease that is a constant potential threat to life (eg, severe congestive heart failure, end-stage renal failure)
V The patient is morbid and is at substantial risk of death within 24 hours (with or without a procedure)
E Emergency status: in addition to indicating underlying ASA status (1–5), any patient undergoing an emergency procedure is indicated by the suffix ”E”


ASGE Guideline

Sedation and anesthesia in GI endoscopy.  Lichtenstein DR, Jagannath S, Baron TH, et al.  ASGE STANDARDS OF PRACTICE COMMITTEE.  Gastrointestinal Endoscopy 2008;68:815-826
ASA classification
ClassDescription
IThe patient is normal and healthy.
IIThe patient has mild systemic disease that does not limit activities (eg, controlled hypertension or controlled diabetes without systemic sequelae).
IIIThe patient has moderate or severe systemic disease that does not [sic] limit the activities (eg, stable angina or diabetes with systemic sequelae).
IVThe patient has severe systemic disease that is a constant threat to life (eg, severe congestive heart failure, end-stage renal failure).
VThe patient is morbid and is at a substantial risk of death within 24 hours (with or without a procedure).
EEmergency status: in addition to indicating the underlying ASA status (1-5), any patient undergoing an emergency procedure is indicated by suffix “E.”


Quality Assurance Task Group of the National Colorectal Cancer Roundtable

Standardized Colonoscopy reporting and data system:  report of the Quality Assurance Task Group of the National Colorectal Cancer Roundtable.  Lieberman D, Nadel M, Smith RA, et al.  Gastrointestinal Endoscopy 2007;65:757-766 

ASA classification system (with Quality Assurance Task Force corollary definitions):

Class 1
Patient has no organic, physiologic, biochemical, or psychiatric disturbance (healthy,no comorbidity). 
Class 2
Mild-to-moderate systemic disturbance caused either by the condition to be treated surgically or by other pathophysiologic processes (mild-to-moderate condition, well controlled with medical management; examples include diabetes, stable coronary artery disease, stable chronic pulmonary disease). 
Class 3
Severe, systemic disturbance or disease from whatever cause, even though it may not be possible to define the degree of disability with finality (disease or illness that severely limits normal activity and may require hospitalization or nursing home care; examples include severe stroke, poorly controlled congestive heart failure, or renal failure). 
Class 4
Severe systemic disorder that is already life threatening, not always correctable by the operation (examples include coma, acute myocardial infarction, respiratory failure requiring ventilatory support, renal failure requiring urgent dialysis, bacterial sepsis with hemodynamic instability). 
Class 5
The moribund patient, who has little chance of survival.

Cleveland Clinic

www.clevelandclinic.org accessed January 4, 2009
 
ASA PS Category
Preoperative Health Status
Comments, Examples
*ASA PS classifications from the American Society of Anesthesiologists
ASA PS 1
Normal healthy patient
No organic, physiologic, or psychiatric disturbance; excludes the very young and very old; healthy with good exercise tolerance
ASA PS 2
Patients with mild systemic disease
No functional limitations; has a well-controlled disease of one body system; controlled hypertension or diabetes without systemic effects, cigarette smoking without chronic obstructive pulmonary disease (COPD); mild obesity, pregnancy
ASA PS 3
Patients with severe systemic disease
Some functional limitation; has a controlled disease of more than one body system or one major system; no immediate danger of death; controlled congestive heart failure (CHF), stable angina, old heart attack, poorly controlled hypertension, morbid obesity, chronic renal failure; bronchospastic disease with intermittent symptoms
ASA PS 4
Patients with severe systemic disease that is a constant threat to life
Has at least one severe disease that is poorly controlled or at end stage; possible risk of death; unstable angina, symptomatic COPD, symptomatic CHF, hepatorenal failure
ASA PS 5
Moribund patients who are not expected to survive without the operation
Not expected to survive > 24 hours without surgery; imminent risk of death; multiorgan failure, sepsis syndrome with hemodynamic instability, hypothermia, poorly controlled coagulopathy
ASA PS 6
A declared brain-dead patient who organs are being removed for donor purposes
 


Colorado Standards for Hospitals and Health Facilities
Standard defining admission criteria for ambulatory surgery centers (6 CCR 1011-1, last amended 01/19/11, effective 03/02/11)

The physicians performing the procedure shall document in writing that the patient is in good health or that any pre-existing health conditions are adequately controlled, require no special management and are such that performance of the procedure in an ASC, rather than a hospital setting, does not pose an increased risk to the patient.
 
 
Prior to 03/02/11 the language in this regulation was:

The patient must be in good health or have mild systemic disease which is under good control and does not require special management.