ASA PS Classification System: Physical Status Definitions and Examples

ASA PHYSICAL STATUS CLASSIFICATION SYSTEM
Last approved by the ASA House of Delegates on October 15, 2014
Table 1: Current definitions (NO CHANGE) and Examples (NEW)

ASA PS
Classification
Definition
A normal healthy patient
ASA I
A patient with mild systemic
disease
ASA II
A patient with severe

systemic disease
ASA III
ASA IV
ASA V
ASA VI
A patient with severe

systemic disease that is a
constant threat to life
A moribund patient who is

not expected to survive
without the operation
Examples, including, but not limited to:

Healthy, non-smoking, no or minimal alcohol
use
Mild diseases only without substantive
functional limitations. Examples include (but not
limited to): current smoker, social alcohol
drinker, pregnancy, obesity (30<BMI<40), wellcontrolled DM/HTN, mild lung disease
Substantive functional limitations;
One or more moderate to severe diseases.
Examples include (but not limited to): poorly
controlled DM or HTN, COPD, morbid obesity
(BMI 40), active hepatitis, alcohol dependence
or abuse, implanted pacemaker, moderate
reduction of ejection fraction, ESRD undergoing
regularly scheduled dialysis, premature infant
PCA < 60 weeks, history (>3 months) of MI,
CVA, TIA, or CAD/stents.
Examples include (but not limited to): recent (<3
months) MI, CVA, TIA, or CAD/stents, ongoing
cardiac ischemia or severe valve dysfunction,
severe reduction of ejection fraction, sepsis, DIC,
ARD or ESRD not undergoing regularly
scheduled dialysis
Examples include (but not limited to): ruptured
abdominal/thoracic aneurysm, massive trauma,
intracranial bleed with mass effect, ischemic
bowel in the face of significant cardiac pathology
or multiple organ/system dysfunction
A declared brain-dead
patient whose organs are
being removed for donor
purposes
*The addition of E denotes Emergency surgery:

(An emergency is defined as existing when delay in treatment of the patient would lead to a significant
increase in the threat to life or body part)
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
Appendix 1
References related to use of the ASA PS Classification System
1. Guidelines for the use of Sedasys by non-anesthesia trained proceduralist and nurse.
http://www.sedasys.com/
2. American College of Surgeons proposed guidelines for care of pediatric surgical patients.
Journal of the American College of Surgeons, 2014;218:479-48
3. Guidelines for local anesthesia cases in a major academic center. Monitoring patients
receiving local anesthesia, MGH, Perioperative Nursing, OR L. 16
4. Office Based Procedure guidelines
https://phpmm.org/Portals/79/WebFiles/Provider%20Manual%20Updates/Clinical%20Guidel
ines/MQIC%202009%20Office-Based%20Surgery%20Guideline.pdf
5. Preoperative testing guidelines. http://www.choosingwisely.org/doctor-patient-lists/americansociety-of-anesthesiologists/
Appendix 2
Selected References Addressing Inter-Rater Reliability of the ASA PS Classification System
1. Owens WD, Felts JA, et al. ASA physical status classifications: A study of consistency of
ratings. Anesthesiology. 1978;49:23943 (Editorial by Keats AS. The ASA Classification of
Physical Status A Recapitulation. Anesthesiology 1978;49:233-6)
2. Haynes SR, Lawler PG. An assessment of the consistency of ASA physical status
classification allocation. Anaesthesia. 1995;50:195-9
3. Mak PH, Campbell RC et al. The ASA physical status classification: inter-observer
consistency. Anaesth Intensive Care 2002;30:633-40
4. Aronson WL, McAuliffe MS, Miller K. Variability in the American Society of
Anesthesiologists Physical Status Classification Scale. AANA J. 2003;71:26574
5. Jacqueline R, Malvivya S et al. An assessment of interrater reliability of the ASA physical
status classification in pediatric surgical patients. Paediatr Anaesth 2006;16:928-31
6. Burgoyne LL, Smeltzer MP. How well do pediatric anesthesiologists agree when assigning
ASA physical status classifications to their patients. Paediatr Anaesth 2007;17:956-62
7. Bernard PA, Makin CE et al. Variability of ASA physical status class assignment among
pediatric sedation practitioners. Int J Adolesc Med Health 2009;21:213-20
8. Cuvillon P, Nouvellon E et al. American Society of Anesthesiologists' physical status system:
a multicentre Francophone study to analyse reasons for classification disagreement. Eur J
Anaesthesiol 2011;28:742-7
9. McMillan M, Brearley J. Assessment of the variation in American Society of
Anesthesiologists Physical Status Classification assignment in small animal anaesthesia. Vet
Anaesth Analg. 2013 May;40(3):229-36
10. Sankar A, Johnson SR et al. Reliability of the American Society of Anesthesiologists physical
status scale in clinical practice. Br J Anaesth 2014 Apr 11 (epub ahead of print)

ASA PS Classification System: Physical Status Definitions and Examples

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ASA PHYSICAL STATUS CLASSIFICATION SYSTEM

Last approved by the ASA House of Delegates on October 15, 2014

Table 1: Current definitions (NO CHANGE) and Examples (NEW)

A patient with severe

A patient with severe

A moribund patient who is

Examples, including, but not limited to:

*The addition of E denotes Emergency surgery:

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