Changes in American Society of Anesthesiologists Physical Status Distribution and Prognostic Performance…

Cohort studyJournal of clinical medicine· May 2026

Changes in American Society of Anesthesiologists Physical Status Distribution and Prognostic Performance During the 2024 South Korean Healthcare Crisis: A Large-Scale Retrospective Cohort Study.

Chan-Sik Kim, Sang-Wook Lee

Perioperative MedicineCohort studyQ2IF 3.5

ASA physical status score better predicted 30-day mortality during Korea's 2024 crisis

Changes in American Society of Anesthesiologists Physical Status Distribution and Prognostic Performance During the 2024 South Korean Healthcare Crisis: A Large-Scale Retrospective Cohort Study.

Chan-Sik Kim, Sang-Wook Lee

Journal of clinical medicine · May 2026 · Q2 in General Medicine

Background

The American Society of Anesthesiologists Physical Status (American Society of Anesthesiologists Physical Status) classification is widely used for perioperative risk stratification but is subject to inter-rater variability.

Methods

In this single-center retrospective cohort study, surgical patients during the pre-crisis (January 2022-December 2023) and crisis (March 2024-August 2025) periods were matched 1:2 by propensity score on age, sex, Charlson Comorbidity Index, surgical specialty, emergency status, and anesthesia type.

n = 53,895 cases

Results

AUROC scale to 1.0, crisis-era ASA scores predicted death far more accurately

Crisis

0.891AUC

Pre-crisis

0.827AUC

More results

A total of 53,895 cases (35,930 pre-crisis; 17,965 crisis) were matched, with all post-matching standardized mean differences below 0.1.

The American Society of Anesthesiologists Physical Status × crisis interaction remained significant after adjustment ( p = 0.014).

More results

Discrimination for intensive care unit admission was similar between periods.

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Conclusion

American Society of Anesthesiologists Physical Status classifications assigned during the crisis period were associated with higher discrimination for 30-day mortality than those from the pre-crisis period, suggesting that the operational performance of perioperative risk-assessment tools may vary with evaluator context and broader healthcare system conditions.

Changes in American Society of Anesthesiologists Physical Status Distribution and Prognostic Performance During the 2024 South Korean Healthcare Crisis: A Large-Scale Retrospective Cohort Study.

Changes in American Society of Anesthesiologists Physical Status Distribution and Prognostic Performance During the 2024 South Korean Healthcare Crisis: A Large-Scale Retrospective Cohort Study.

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