Anesthesia Alert
AA
3 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • N O V E M B E R 2 0 1 7
A NEBULOUS SYSTEM
ASA Scores Don't Measure Operative Risk
The term "ASA scores" is a
misnomer. Those Roman
numerals are physical status
scores designed to measure
pre-operative health status,
not operative risk, which
really diminishes the value of
the ASA Physical Status
Classification System when
determining a patient's surgi-
cal risk.
For one thing, ASA scores are subjective. What one person sees
as a PS III patient, another sees as a PS IV. I've seen it happen. A
returning patient, with no physical changes, sees a different
provider and gets a different rating. The system also leans heavily
on the word "systemic," which can be confusing. As another col-
league points out, a heart attack, though grave, is a "local" rather
than systemic disease. So myocardial infarction patients, in the
absence of any other systemic diseases, don't really fit into any
one category. But they have poorer post-surgery survival rates.
Moreover, people often create their own criteria, and some sur-
gical facility websites list incorrect definitions. At any rate, here's
a capsule summary of 1 through 5:
PS I. The patient is completely healthy and can tolerate exer-
cise.
PS II. The patient has mild or well-controlled systemic disease
of one body system, or is a smoker but shows no evidence of
• 'ASA SCORES' How well do physical status scores determine
a patient's surgical risk?
Pamela
Bevelhymer,
RN,
BSN,
CNOR
