COPD, or is mildly obese, or is older than 70, but has no function-
al limitations.
PS III. The patient has a severe systemic disease that isn't inca-
pacitating, but that results in some functional limitation, or has a
controlled disease of more than one body system or of a major
system, with intermittent symptoms or chronic renal failure.
PS IV. The patient has incapacitating disease that's a constant
threat to life, or at least 1 severe disease that's poorly controlled or
at end stage.
PS V. The patient is moribund and not expected to live 24 hours,
with or without surgery.
The problem? With the exceptions of 1 and 5, the system is neb-
ulous, at best. Consider, for example, a 71-year-old man with
well-controlled hypertension and well-controlled diabetes. Let's
say he walks a mile every day and has no other limitations. Since
he's 71, he can't be a PS I. And since he has controlled hyperten-
sion and diabetes, he drops all the way down to a III. But is that
an accurate assessment? Frankly, no. And it helps illustrate why
many anesthesiologists and CRNAs think the system is flawed.
This calls to mind an anesthesia colleague. Whenever a circula-
tor asks, "What's the ASA?" she replies, "The American Society of
Anesthesiologists!" And she's right!
— Perry V. Ruspantine, CRNA, APRN
N O V E M B E R 2 0 1 7 • O U T PA T I E N T S U R G E R Y. N E T • 3 1
essary:
• Cardiac disease, including unstable coronary syndrome, a heart
attack within the previous 30 days (many facilities say 6 months),
new onset angina, unstable angina resistant to nitroglycerin sublin-
gual, angina at rest, untreated or undiagnosed new-onset atrial fibril-
lation (AF), AF with a resting heart rate greater than 110, active
