Assessment of fitness for anaesthesia and surgery

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. Definition Normal healthy individual Mild systemic disease that does not limit activity Mortality (%) 0.05 0.4

ASA Grade I II III IV V

Severe systemic disease that limits activity but 4.5 is not incapacitating Incapacitating systemic disease which is constantly life-threatening Moribund, not expected to survive 24 hours with or without surgery 25 50

Application of ASA Grading

Cardiovascular disease ASA Grade 2 Angina Hypertension Occasional use of GTN. Well controlled on single agent ASA Grade 3 Regular use of GTN or unstable angina Poorly controlled. Multiple drugs

Diabetes

Well controlled. No complications

Poorly controlled or complications

Respiratory disease
ASA Grade 2 COPD Asthma Cough or wheeze. Well controlled ASA Grade 3 Breathless on minimal exertion

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