ASA P HYSICAL STATUS CLASSIFICATION

ASA physical
status
Definition

II

III

IV

Healthy

Mild systemic
disease

Severe systemic
disease but not
incapacitating

Age

> 3 months to
< 65 years

3 months or
65 to 84 years

1 month preterm
NB or 85 years

Functional
capacity;
walk up 1
flight of stair
or 200 m. on
the level
Medical
status

Complete without
distress

Rest at completion
because of distress

Stop en route
because of distress

Unable to do

No organic,
physiologic, or
psychiatric
disturbance

Single/multiple
systemic disease(s)
with good control
No functional
limitations or vital
organ involvement

Poorly controlled
systemic disease(s)

Poorly controlled
systemic disease(s)

Some functional
limitations
No immediate life
threatening
condition

Significant functional
limitation
Constant potential
threat to life

0.06 0.08

0.27 0.4

1.8 4.3

7.8 23

Mortality rate
(%)
Emergency
status

Incapacitating
disease

VI

Dying

Declared brain
death

End stage disease(s)

and not expected to
survive within 24
hours

Clinically dead
patients awaiting
organ harvest

9.4 51

In addition to indicating ASA physical status, any patient undergoing an emergency operation is indicated by the suffix E, e.g., ASA III E

Examples of ASA physical status classification

ASA physical
status
Physiological
status

III

IV

Healthy pregnant
woman
Active allergies

Pre-existing disease
in pregnancy, GDM,
PIH,
Mild pre-eclampsia

Severe preeclampsia,
Eclampsia,
HELLP syndrome

CVS

HT with BP <
140/90 mmHg

BP > 180/110
mmHg
Stable angina
MI > 6 months /
Cardiac arrhythmia
without
hemodynamic
instability
Compensated heart
failure
EF 25% - 50%

Unstable angina
Acute MI
MI <6 months
Uncontrolled cardiac
arrhythmias with
hemodynamic
instability
Severe heart failure
EF < 25%

RS

Well controlled
asthma (attack < 1
per week)
Heavy smoker (> 20
pack year) without
COPD

Stress-/ exerciseinduced or
hospitalized asthma
COPD on
medications

Asthma or COPD
with exacerbation

CNS

Well controlled
epilepsy
Parkinsonism
Dementia
Alzeihmers disease
GCS > 13

Stroke > 6 months

with or without
neurologic sequelae

Uncontrolled
epilepsy
Stroke < 6 months
or bed-ridden status

GCS 9 to 12

GCS < 8

Normal healthy
patient

II

Ruptured aortic
aneurysm
Sepsis syndrome
with hemodynamic
instability
S/P CPR

VI

Examples of ASA physical status classification

ASA physical
status
Endocrine

II

III

IV

Well controlled
diabetes of any type
Controlled hyper- or
hypothyroidism with
clinically
euthyroidism
Obesity class II
(BMI 35 39.99)

Poor controlled
diabetes
Symptomatic hypo/hyperthyroidism

DKA / Hyperosmolar
nonketotic acidosis
Thyroid crisis

Obesity class III or

morbid obesity
(BMI 40 44.99)

Obesity class IV
(BMI 45 )

GI

Cirrhosis child A
Significant liver
enzyme abnormality

Cirrhosis child B

Cirrhosis child C

Hepatic
encephalopathy

Hematology

Anemia (Hct < 30%)

Thalassemia minor
e.g. Thalassemia
trait, Hb E, Hb CS,
Hb H
Platelet 50,000100,000
INR 1.2-1.5

Symptomatic anemia
(Hct < 25%)
Thalassemia major
Platelet < 50,000
INR > 1.5

Platelet < 50,000 r

INR > 1.5 with
bleeding

DIC

Renal

Renal impairment
CKD stage 1-2
Asymptomatic
electrolyte imbalance

CKD stage 3-5

ESRD
Symptomatic
electrolyte imbalance

ESRD with volume

overload or uremia
Hepatorenal
syndrome

Others

SIRS
Malnutrition
(BMI < 16.5)
Hypoalbuminemia
(albumin < 2.5)

Septicemia

Septic shock

MODS

VI