ASSESSMENT OF PATIENTS FITNESS FOR ENDOSCOPY:
American Society of Anesthesiologists (ASA) grade is the most commonly used grading system to
assess fitness for surgery or Endoscopy. Use the following information and table to help you assess the
risk v. benefit for your patient:

Medical co-morbidity increases the risk associated with anaesthesia and surgery

ASA accurately predicts morbidity and mortality

50% of patients presenting for elective surgery are ASA grade 1

‘Operative mortality’ for these patients is less than 1 in 10,000

Risks for endoscopic procedures increase with their complexity.
% mortality
predicted
ASA
Assessment of Fitness
Class
I
Healthy Patient
Class
II
Mild Systemic Disease, No Functional Limitations, No acute problems
(e.g. controlled hypertension, mild diabete, chronic bronchitis, asthma)
0.4
Class
III
Severe Systemic Disease, Definite functional limitation (e.g. brittle
dabetic, frequent angina, mycardial infarction)
4.5
Class
IV
Severe systemic disease with acute, unstable symptoms (e.g. recent [3
months] mycardial infarction, congestive heart failure, acute renal
failure, ketoacidosis, uncontrolled active asthma)
25
Class
V
Severe systemic disease with imminent risk of death, moribund
0.05
Clinical Application of ASA Grading
Cardiovascular disease: ASA Grade 2
Angina
Occasional use of GTN.
50
ASA Grade 3
Regular use of GTN
or unstable angina
Hypertension
Well controlled on single agent
Poorly controlled. Multiple drugs
Diabetes
Well controlled.
No complications
Poorly controlled or complications
Respiratory disease
COPD
Asthma
ASA Grade 2
Cough or wheeze.
Well controlled
Well controlled with inhalers
ASA Grade 3
Breathless on minimal exertion
Poorly controlled.
Limiting lifestyle
Bibliography
Arenal J J, Bengoechea-Beeby M. Mortality associated with emergency abdominal surgery in the elderly. Can J Surg 2003;
46: 111-116.
El-Haddawi F, Abu-Zidan F M. Jones W. Factors affecting the surgical outcome in the elderly at Auckland Hospital. Aust NZ
J Surg 2002; 57: 798-805