Is the ASA classification universal? - a survey of Portuguese anaesthetist.

Abstract

Background and aims: The classification of the physical status of the American Society of Anesthesiology (ASA) has 6 categories, being the most used score in the preoperative evaluation. Although it is related with anesthetic morbidity and mortality, inconsistent evaluations of the same patients have been observed among different anesthesiologists. The aim of this study is to evaluate the variability in the evaluation of ASA physical status classification among Portuguese anesthesiologists. Methods: Prospective study, in which an electronic questionnaire was distributed to Portuguese anesthesiologists with questions regarding their demographic characteristics, professional experience, place of work, and how they would've categorized 15 clinical cases in ASA classification. These cases were based on other studies. The agreement among participants was evaluated through intraclass correlation coefficient (ICC). A value of p <0.05 was assumed to be statistically significant. Results: We got 259 answers. Median age of participants was 47 years. 170 were female and 77 males. 203 were anesthesiology fellows and 43 residents. 90.5% work in the public sector. Compared with the authors' classification, participants' agreement ranged from 3 to 15 responses, with a mean of 9.2 (SD +/- 2.4). In none of the cases was observed a total agreement with the previous classification (max. 92.3%), and the ICC among the participants was 0.726 (0.585; 0.869; p <0.001) showing a moderate degree of agreement. Conclusion: The results of this sample revealed that the agreement among Portuguese anesthetists is satisfactory and is similar with the values observed in the literature.