ASA Physical Status Determination by General Internists and Impact on Cardiac Risk Assessment.

Area of Science:

• Anesthesiology
• Internal Medicine
• Cardiology

Background:

• Accurate cardiac risk estimation is crucial for preoperative patient assessment.
• The American Society of Anesthesiologists (ASA) physical status score is frequently used in cardiac risk calculators.
• Variations in ASA score assignment could impact patient risk stratification.

Purpose of the Study:

• To evaluate the agreement between ASA scores assigned by general internists and anesthesiologists.
• To determine if discrepancies in ASA scores affect cardiac risk estimations.

Main Methods:

• An observational study involving military veterans undergoing preoperative evaluation.
• Comparison of ASA scores assigned by General Internal Medicine residents and anesthesiologists.
• Calculation of Gupta Cardiac Risk Scores based on both sets of ASA scores.

Main Results:

• Low concordance (37.3%) between internist and anesthesiologist ASA scores.
• Internists assigned lower scores in 62.0% of cases, with low interrater reliability (κ = 0.08).
• Discrepancies led to differing cardiac risk profiles, with fewer patients exceeding 1% risk using internist-assigned scores.

Conclusions:

• General internists tend to assign significantly lower ASA scores compared to anesthesiologists.
• These systematic differences in ASA scoring can lead to substantially different cardiac risk assessments.
• Standardizing ASA score assignment is important for accurate preoperative cardiac risk evaluation.