Reliability of American society of anesthesiologists physical status classification

The American Society of Anesthesiologists Physical Status (ASA‑PS) classification is a widely used grading system for the pre‑operative health of a surgical patient. It was originally developed in 1941 by Saklad et al. and then modified in 1961 by Dripps et al.[1] into a five‑class version. According to other researchers, the ASA‑PS classification should be modified and adapted to the paediatric population because there are many differences between the physiology and pathology of adults and children. Many studies have tested the relation between the ASA classification and several outcomes[2,3] such as mortality, cardiac arrest, morbidity, length of stay and predictors of blood loss. The reliability of the ASA‑PS classification has been widely evaluated,[4,5] but there are different conclusions on the ASA‑PS classification reliability. There is no agreement on the level of reliability of the scale. We conducted a systematic review on the state of studies on the reliability of the ASA‑PS classification. To our knowledge, there is only one review on the ASA‑PS classification,[6] and there are no systematic reviews on its reliability. The primary aim was to check the state of studies on the reliability of the ASA‑PS classification for the broad population of adults and children waiting for surgery.