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ASA Physical Status

Classification System

Physical Status Classification System

ASA Physical Status 1
A normal healthy patient

ASA Physical Status 2

A patient with mild systemic disease

ASA Physical Status 3

A patient with severe systemic disease

ASA Physical Status 4

A patient with severe systemic disease that is a constant threat to life

ASA Physical Status 5

A moribund patient who is not expected to survive without the operation

ASA Physical Status 6

A declared brain-dead patient whose organs are being removed for donor
purposes

 There is no additional information that can be

helpful to further define these categories. It is
logical to expect a missing class between ASA 2
and ASA 3 for a systemic disease which is
neither mild nor severe, but is of moderate
nature. It is also not clear what will be the ASA
classification of a patient who is suffering
simultaneously from two, three or more
systemic diseases (which might be of different
severity).
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The word 'systemic' in this classification

creates a lot of confusion
Heart attack (myocardial infarction), though grave,
is a 'local' disease and is not a 'systemic' disease,
so a patient with recent (or old) heart attack, in the
absence of any other systemic disease, does not
truly fit in any category of the ASA classification, yet
has poor post-surgery survival rates.
Cirrhosis of the liver, COPD, severe asthma,
peri-nephric abscess, badly infected wounds,
intestinal perforation, skull fracture etc. are not
systemic diseases.
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These, and other severe heart, liver, lung,

intestinal or kidney diseases, although they
greatly affect physical status of patient and risk
for poor outcomes, cannot be labelled as
systemic disease (which means a generalized
disorder of the whole body like hypertension or
diabetes mellitus). Local diseases can also
change physical status but has not been
mentioned in ASA classification.

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 This classification system assumes that age of the

patient has no relation to physical fitness, which is
not true. Neonates and the elderly, even in the absence
of any systemic disease, tolerate otherwise similar
anesthetics poorly in comparison to young adults.
This classification ignores patients with malignancy (
cancer). This classification system could not be improved
to a more elaborated and scientific form, probably
because it is often used for cost reimbursement.

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 Some anesthesiologists now propose that like an 'E'

modifier for emergency, a 'P' modifier for pregnancy
should be added to the ASA score.
Also, the ASA classification doesn't describe the general
health status of the patient when excluding the condition
that indicates the surgery.

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Physical
Status
Classification
System
And
Correlation
with Mortality

American Society of
Anesthesiologists -newsletter
September 2002

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References
Fehrenbach, Margaret J.
"ASA Physical Status Classification System". Retrieved
2007-07-09.
Little JP (1995). "Consistency of ASA
grading". Anaesthesia 50 (7): 6589. PMID 7653772.
Haynes SR, Lawler PG (1995). "An assessment of the
consistency of ASA physical status classification
allocation". Anaesthesia 50 (3): 1959. doi:
10.1111/j.1365-2044.1995.tb04554.x. PMID 7717481.

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FAKULTAS KEDOKTERAN UNDIP DEPARTEMEN ANESTESI

dr. JERRY FHS

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