Assignment of ASA-physical status relates to anesthesiologists’ experience: a survey-based national-study

Abstract

BackgroundThe American Society of Anesthesiologists physical status (ASA-PS) is a grading system adopted worldwide by anesthesiologists to classify the overall health status of patients. Its importance is demonstrated not only by its routine use in clinical practice, but also by its deployment in other healthcare-related environments. However, a weak/moderate inter-rater reliability for ASA-PS has been previously shown, and although definitions and clinical examples of each class are provided by ASA, doubts remain on the individual factors influencing assignment to an ASA-PS class. The aim of this study was to investigate whether and how an anesthesiologist’s experience affects classification into a specific ASA-PS class.MethodsAn online survey presenting eight fictitious patients was administered to a group of Italian anesthesiologists and residents. Respondents were asked to assign each of the eight patients to a specific ASA-PS class. Anesthesiologists were subdivided into five classes according to years of experience as an anesthesiologist.ResultsSix hundred one surveys were correctly completed. The highest mean number of correct answers was obtained by residents (3.95 ± 1.13), with the number decreasing progressively with increasing work experience. The lowest value was recorded in the most experienced group (3.13 ± 1.25). Inter-rater reliability was weak/moderate in all experience level groups (k = 0.38).ConclusionsLow inter-reliability of the ASA-PS and the experience-dependence of the anesthesiologist in assigning classifications must be taken into account when evaluating a patient, particularly in settings where wide differences in experience are present.

Deutschlandweite Studie zur präanästhetischen Risikoeinschätzung mithilfe der ASA-Klassifikation beim Hund

“…Im Rahmen unserer Studie ergab sich ebenfalls nur eine schwache Übereinstimmung aller Bewerter untereinander (κ = 0,33). Wie von den Autoren angenommen, bestand insgesamt sogar eine höhere Abweichung der ASA-Klassen als in vergleichbaren humanmedizinischen Studien [14] [17]. Ein Grund hierfür könnte sein, dass die ASA-Klassifizierung in der Veterinärmedizin nicht so flächendeckend gelehrt, verbreitet und angewendet wird wie in der Humanmedizin.…”

Safety and efficacy of endoscopist-directed balanced propofol sedation during endoscopic retrograde cholangiopancreatography

“…As reflected by the inherent differences between the two study cohorts reported in this study, the major distinction between them in the data collected was in the distribution of ASA scores within the cohorts. The ASA scoring tool has been shown to lack high interobserver reliability in grading and consistently reported differences have not been found between graders in relation to training, specialty, experience or age [48][49][50]. To our knowledge, there have been no studies specifically comparing the interobserver reliability of grading between endoscopist and anesthesiologist.…”

A follow-up study of hip arthroplasty in patients with chronic renal failure on dialysis

“…The preoperative risk was evaluated according to the American Society of Anesthesiologists guidelines [12]. This study was approved by our institutional review board, and written informed consent was obtained from all the patients included.…”