ASA Physical Classification System

The American Society of Anesthesiologists (ASA) Physical Status classification system was initially created in 1941 by the American Society of Anesthetists, an organization that later became the ASA.

The purpose of the grading system is simply to evaluate the degree of a patient's "sickness" or "physical state" before selecting the anesthetic or before performing surgery. Describing patients' preoperative physical status is used for recordkeeping, for communicating between colleagues, and to create a uniform system for statistical analysis. The grading system is not intended for use as a measure to predict operative risk.

The modern classification system consists of six categories, as described below.

ASA Physical Status (PS) Classification System*:
ASA PS Category Preoperative Health Status Comments, Examples
*ASA PS classifications from the American Society of Anesthesiologists
ASA PS 1 Normal healthy patient No organic, physiologic, or psychiatric disturbance; excludes the very young and very old; healthy with good exercise tolerance
ASA PS 2 Patients with mild systemic disease No functional limitations; has a well-controlled disease of one body system; controlled hypertension or diabetes without systemic effects, cigarette smoking without chronic obstructive pulmonary disease (COPD); mild obesity, pregnancy
ASA PS 3 Patients with severe systemic disease Some functional limitation; has a controlled disease of more than one body system or one major system; no immediate danger of death; controlled congestive heart failure (CHF), stable angina, old heart attack, poorly controlled hypertension, morbid obesity, chronic renal failure; bronchospastic disease with intermittent symptoms
ASA PS 4 Patients with severe systemic disease that is a constant threat to life Has at least one severe disease that is poorly controlled or at end stage; possible risk of death; unstable angina, symptomatic COPD, symptomatic CHF, hepatorenal failure
ASA PS 5 Moribund patients who are not expected to survive without the operation Not expected to survive > 24 hours without surgery; imminent risk of death; multiorgan failure, sepsis syndrome with hemodynamic instability, hypothermia, poorly controlled coagulopathy
ASA PS 6 A declared brain-dead patient whose organs are being removed for donor purposes


This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit or This document was last reviewed on: 10/4/2015