ASA Physical Status Classification System

The ASA classification system is a tool that anesthesiologists use on the day of your surgery. It grades your health to help your care team prepare you for surgery. It isn’t the only factor used to identify the risks of a surgical procedure.

What is ASA classification?

The American Society of Anesthesiologists (ASA) physical status classification system is a grading system to determine the health of a person before a surgical procedure that requires anesthesia.

The purpose of ASA classification is to:

  • Keep a record of your health before surgery.
  • Provide a uniform system for all anesthesiologists to use.
  • Help predict your risk of surgical complications, along with other factors like the type of surgery, your age, the extent of the procedure, surgery timeframe and more.

Note: On its own, the ASA classification system isn’t a prediction of the outcome of surgery. This classification can help determine your surgical risk but isn’t the only factor that a surgical team considers.


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What is ASA?

ASA is an abbreviation for the American Society of Anesthesiologists. The American Society of Anesthetists, an organization that later became the ASA, created the classification system in 1941.

What are the ASA classification guidelines?

ASA classification uses a grading system of I (one) through V (five), with I identifying a person in good health and V as a person with a severe, life-threatening condition. The sixth (VI) status identifies deceased organ donors.

The ASA provides examples for adults and children in each grade. The hospital in which you receive care may have more specific examples related to their specialties in addition to the examples provided by ASA.

ASA classification chart

ASA Physical Status Classification
A person in good health.
Adult Examples
A person who doesn’t smoke tobacco products and minimally uses alcohol.
Pediatric Examples
A child in a healthy BMI range for their age.
A mild but well-managed or treated condition.
Adult Examples
A person who is pregnant, has a mild lung condition, may smoke tobacco products or drinks alcohol socially or has overweight.
Pediatric Examples
A child with mild asthma, a well-managed abnormal heart rhythm (dysrhythmias) or mild obstructive sleep apnea.
A serious condition that has an impact on a person’s overall health.
Adult Examples
A person who has a BMI greater than 40, alcohol use disorder or an implanted pacemaker.
Pediatric Examples
A child with severe asthma, a heart abnormality, epilepsy or severe obstructive sleep apnea.
A severe condition that’s life-threatening.
Adult Examples
A person with a severe infection (sepsis), is on dialysis regularly or has severe heart disease.
Pediatric Examples
A child with congestive heart failure, is dependent on a ventilator or is in shock.
A life-threatening condition that needs immediate surgery to increase survival odds.
Adult Examples
A person with an opening in the top part of their aorta (ruptured aneurysm), brain bleeding or multiorgan dysfunction.
Pediatric Examples
A child with brain bleeding (intracranial hemorrhage), respiratory failure or severe liver disease.
A deceased person who is an organ donor.
Adult Examples
The adult is deceased.
Pediatric Examples
The child is deceased.


When is the ASA classification used?

Your care team will use the ASA classification system before you receive anesthesia for surgery on the day of your procedure. They’ll determine your ASA score shortly before your surgery to get the most accurate status.

Who is an anesthesiologist?

An anesthesiologist is a healthcare provider who specializes in giving people anesthesia. Anesthesia is a medication that prevents you from feeling pain during a surgical procedure. Some anesthetic medications numb certain parts of your body, while other medications numb your brain to induce sleep for more invasive surgical procedures. An anesthesiologist will monitor you during your procedure so you don’t feel any pain.

A note from Cleveland Clinic

The ASA classification system is a grade that helps your anesthesiologist prepare for your surgery. It may be uncomfortable having your health marked with a “grade,” but this is a form of record keeping to monitor your treatment and make sure you’re getting adequate care catered to your specific needs on the day of your surgery. This classification system doesn’t identify your risk of surgery and should only be used with other factors to evaluate the risks of the procedure.

Medically Reviewed

Last reviewed on 04/12/2023.

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