Specialist-centered ASA-PS classifications during the crisis period demonstrated higher discrimination for 30-day mortality than resident-led pre-crisis assessments (ΔAUC = 0.064, p < 0.001).
Cohort (n=53,895)
No
Does the context of ASA-PS assessment (specialist-centered during a crisis vs resident-led pre-crisis) affect its prognostic discrimination for 30-day mortality in surgical patients?
The prognostic performance of the ASA-PS classification for 30-day mortality improved when assessments shifted from resident-led to specialist-centered care during a healthcare crisis.
Effect estimate: ΔAUC 0.064
Absolute Event Rate: 0.891% vs 0.827%
p-value: p=< 0.001
Background: The American Society of Anesthesiologists Physical Status (ASA-PS) classification is widely used for perioperative risk stratification but is subject to inter-rater variability. The 2024 South Korean medical crisis abruptly shifted preoperative ASA-PS assessment from resident-led to specialist-centered care, providing a natural opportunity to examine how this transition affected ASA-PS distribution and prognostic performance. 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. The primary outcome was 30-day mortality; secondary outcomes were postoperative intensive care unit (ICU) admission and length of stay. ASA-PS discrimination was compared between periods using DeLong’s test, and ASA × crisis interaction terms were assessed by the likelihood ratio test. 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. ASA-PS demonstrated higher discrimination for 30-day mortality during the crisis than the pre-crisis period (area under the curve AUC, 0.891 0.863–0.919 vs. 0.827 0.803–0.851; ΔAUC = 0.064, p < 0.001). The ASA-PS × crisis interaction remained significant after adjustment (p = 0.014). Discrimination for ICU admission was similar between periods. Conclusions: ASA-PS 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.
Kim et al. (Sun,) conducted a cohort in Surgical patients (n=53,895). Specialist-centered ASA-PS assessment (crisis period) vs. Resident-led ASA-PS assessment (pre-crisis period) was evaluated on 30-day mortality discrimination (AUC) (ΔAUC 0.064, p=< 0.001). Specialist-centered ASA-PS classifications during the crisis period demonstrated higher discrimination for 30-day mortality than resident-led pre-crisis assessments (ΔAUC = 0.064, p < 0.001).