ASA Grading
- Medical co-morbidity increases the risk associated with anaesthesia and surgery
- American Society of Anesthesiologists (ASA) grade is the most commonly used grading system
- ASA accurately predicts morbidity and mortality
- 50% of patients presenting for elective surgery are ASA grade 1
- Operative mortality for these patients is less than 1 in 10,000.
| ASA Grade
|
Definition
|
Mortality (%)
|
| I |
Normal healthy individual
|
0.05 |
| II |
Mild systemic disease that does not limit activity
|
0.4 |
| III |
Severe systemic disease that limits activity but is not incapacitating
|
4.5 |
| IV |
Incapacitating systemic disease which is constantly life-threatening
|
25 |
| V |
Moribund, not expected to survive 24 hours with or without surgery
|
50 |
Application of ASA Grading
Cardiovascular disease
|
ASA Grade 2 |
ASA Grade 3 |
| Angina |
Occasional use of GTN. |
Regular use of GTN or unstable angina |
| Hypertension |
Well controlled on single agent |
Poorly controlled. Multiple drugs |
| Diabetes |
Well controlled. No complications |
Poorly controlled or complications |
Respiratory disease
|
ASA Grade 2 |
ASA Grade 3 |
| COPD |
Cough or wheeze. Well controlled |
Breathless on minimal exertion |
| Asthma |
Well controlled with inhalers |
Poorly controlled. Limiting lifestyle |
Bibliography
Arenal J J, Bengoechea-Beeby M. Mortality associated with emergency abdominal surgery in the
elderly. Can J Surg 2003; 46: 111-116.
El-Haddawi F, Abu-Zidan F M. Jones W. Factors affecting the surgical outcome in the elderly
at Auckland Hospital. Aust NZ J Surg 2002; 57: 798-805 |