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.
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:
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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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.
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 Physical Status Classification | Definition | Adult Examples | Pediatric Examples |
|---|---|---|---|
| ASA I | A person in good health. | A person who doesn’t smoke tobacco products and minimally uses alcohol. | A child in a healthy BMI range for their age. |
| ASA II | A mild but well-managed or treated condition. | A person who is pregnant, has a mild lung condition, may smoke tobacco products or drinks alcohol socially or has overweight. | A child with mild asthma, a well-managed abnormal heart rhythm (dysrhythmias) or mild obstructive sleep apnea. |
| ASA III | A serious condition that has an impact on a person’s overall health. | A person who has a BMI greater than 40, alcohol use disorder or an implanted pacemaker. | A child with severe asthma, a heart abnormality, epilepsy or severe obstructive sleep apnea. |
| ASA IV | A severe condition that’s life-threatening. | A person with a severe infection (sepsis), is on dialysis regularly or has severe heart disease. | A child with congestive heart failure, is dependent on a ventilator or is in shock. |
| ASA V | A life-threatening condition that needs immediate surgery to increase survival odds. | A person with an opening in the top part of their aorta (ruptured aneurysm), brain bleeding or multiorgan dysfunction. | A child with brain bleeding (intracranial hemorrhage), respiratory failure or severe liver disease. |
| ASA VI | A deceased person who is an organ donor. | The adult is deceased. | The child is deceased. |
| ASA Physical Status Classification | |||
| ASA I | |||
| Definition | |||
| A person in good health. | |||
| Adult Examples | |||
| A person who doesn’t smoke tobacco products and minimally uses alcohol. | |||
| ASA II | |||
| Definition | |||
| 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. | |||
| ASA III | |||
| Definition | |||
| 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. | |||
| ASA IV | |||
| Definition | |||
| 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. | |||
| ASA V | |||
| Definition | |||
| 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. | |||
| ASA VI | |||
| Definition | |||
| A deceased person who is an organ donor. | |||
| Adult Examples | |||
| The adult is deceased. |
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.
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.
Last reviewed by a Cleveland Clinic medical professional on 04/12/2023.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy