Abstract
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.
Highlights
The 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
Three ASA-PS classifications documented by separate medical providers in reference to the same patient were obtained via retrospective chart review
The source of these ASA-PS classification sets were from the internal medicine preoperative appointment, the anesthesia Pre-Anesthesia Unit (PAU) appointment, and the day of surgery (DOS) anesthesia record
Summary
The 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. Care focuses on a preoperative evaluation, early planning for discharge, and post-procedure rehabilitation (Donabedian 1966; Bader 2012) This integrated perioperative system promotes the combination of the three care phases: preoperative, intraoperative, and postoperative. The preoperative component requires comprehensive preoperative evaluations This has resulted in a change from a simple day of surgery evaluation to the establishment of standardized preoperative clinics. The purpose of these more thorough preoperative clinics is to allow for deliberate and careful clinical evaluation with additional investigation and optimization of medical conditions as indicated to promote better patient outcomes and reduce unnecessary medical expenses. There are many types of preoperative clinics with multiple staffing models including providers from a variety of specialties and training levels (Johnson et al 2014)
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