A survey of the ASA physical status classification: significant variation in allocation among Finnish anaesthesiologists

Abstract

Background: The American Society of Anesthesiologists' (ASA) Classification of Physical Health is a widely used grading system for preoperative health of the surgical patient. In previous studies conducted in North America and Great Britain, considerable variation in the ASA classification allocation has been reported. We hypothesised that in smaller and culturally more homogeneous countries there might be less variation in the ASA classification.

Methods: A postal questionnaire depicting 10 hypothetical patient cases was sent to 249 randomly selected members of the Finnish Society of Anaesthesiologists. Responses of anaesthesiologists working in university teaching and non-teaching hospitals were compared, as well as the answers of specialists and non-specialists.

Results: Responses were received from 108 anaesthesiologists (response rate 43%). There was marked variation in the classification of all the 10 cases: 1 case was classified to all five possible grades (ASA grades I-V). In 2 cases, there was significant variation between anaesthesiologists working in university teaching and non-teaching hospitals. There was no difference in the grading between specialist and non-specialist anaesthesiologists.

Conclusion: In a small and culturally homogeneous country, like Finland, there exists similar wide variation in the ASA classification as has been previously reported from larger and culturally more heterogeneous countries. The significant variation should always be considered when using this classification in clinical or scientific work.