ASA physical status classification system: Is it consistent amongst providers and useful in determining need for pre-operative evaluation resources?

In the current issue of Journal of Clinical Anesthesia, Curatolo1 et al. demonstrate a discrepancy between ASA Physical Status classification assignments made by anesthesiologists and those made by their medical and surgical colleagues (and their mid-level providers) in a hospital-based academic practice. Using brief clinical vignettes, the ASA-PS grading done by non-anesthesiologists was significantly lower and more variable than ASA-PS grading done by anesthesiologists. It follows that institutional policies that reflexively trigger pre-operative workup by ASA-PS classifications determined by surgeons and their physician-extenders independent of evaluation by anesthesiologists could create practice variability that leads to under- and over-use of pre-operative evaluation resources.

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