The American Society of Anesthesiologists Physical Status Score and Risk of Perioperative Infection

To the Editor. —As an anesthesiologist who administers "prophylactic" antibiotics to patients in the perioperative period, I welcome and applaud the recent article by Dr Goldmann and colleagues1about the emergence and spread of resistant microorganisms in hospitals. I agree with Goldmann et al that reducing routine use of broad-spectrum antibiotics will involve a multidisciplinary approach, and this approach will take place only when hospital leadership demands it. However, I must criticize the authors' use of the physical status score, as determined by criteria from the American Society of Anesthesiologists (ASA), to determine a patient's susceptibility to a perioperative infection. The system in use today was originally published by Saklad in 1941,2modified to its current form by Dripps et al in 1961,3and remains essentially unchanged today. Although many studies have been performed to determine the accuracy of this scoring system with regard to surgical mortality,