World Anaesthesia Issue 14

Issue 14 (2002) Article 5: Page 1 of 1

ASA AND CEPOD SCORING

Dr Richard Walker, Ashburton, UK

Several scoring systems have been devised to describe patients scheduled for surgery and anaesthesia, the best known are the ASA and the CEPOD scores.

The American Association of Anaesthetists (ASA) score subjectively categorises patients into five subgroups by preoperative physical fitness. It was devised in 1941 by the ASA as a statistical tool for retrospective analysis of hospital records. Since inception it has been revised on several occasions and now also includes an “E” suffix denoting an emergency case.[1]

ASA classification makes no adjustment for age, sex, weight, or for pregnancy, nor does it reflect the nature of the planned surgery, the skill of the anaesthetist or surgeon, the degree of pre-theatre preparation or facilities for postoperative care. The ASA score does not give a prediction of risk for a particular patient or operation. Since underlying fitness is an important predictor of survival from surgery, the ASA score has some correlation with outcome. As it is simple and widely understood, it is commonly used as a part of the preoperative assessment, and is an easy tool for audit.

In the UK patients are coded according to their ASA and CEPOD scores. These describe the patient from the perspectives of basic risk banding and urgency of surgery. The scores allow anaesthetists and surgeons to describe their workload which may be helpful for audit purposes. Research into perioperative outcome use these scores widely as descriptors of the surgical population.

References

1. Anon. New classification of physical status. Anesthesiology 1963;24:111
2. Buck N, Devlin HB, Lunn JN. The report of a confidential enquiry into perioperative deaths. The Nuffield Provincial Hospitals Trust and Kings Fund, London (1987)

Table 1. ASA Scores.
Class	Physical status	Example
I	A completely healthy patient	A fit patient with an inguinal hernia
II	A patient with mild systemic disease	Essential hypertension, mild diabetes without end organ damage
III	A patient with severe systemic disease that is not incapacitating	Angina, moderate to severe COPD
IV	A patient with incapacitating disease that is a constant threat to life	Advanced COPD, cardiac failure
V	A moribund patient who is not expected to live 24 hours with or without surgery	Ruptured aortic aneurysm, massive pulmonary embolism
E	Emergency case

Table 2. CEPOD Scores
Grade 1		Elective Operation at time to suit both surgeon and patient
Grade 2		Scheduled Operation within 24 hours. Delayed operation after resuscitation
Grade 3		Urgent Operation between 1 and 3 weeks. Early surgery preferred, but not life saving
Grade 4		Emergency Operation within 1 hour. Immediate operation or resuscitation simultaneous with surgical treatment