The Predictive Value of the American Society of Anesthesiologists Physical Status Classification System for Therapeutic Outcomes in Emergency Cesarean Section at Douala General Hospital, Cameroon

Background: The American Society of Anesthesiologists (ASA) Physical Status classification is a critical preoperative risk assessment tool. Its predictive utility for outcomes in the high-acuity, resource-constrained environment of an emergency surgical setting, such as for emergency Cesarean Section (CS) in Sub-Saharan Africa (SSA), requires validation. This study aimed to evaluate the correlation between the ASA status score and the therapeutic outcomes (maternal and neonatal) of patients undergoing emergency CS at Douala General Hospital (DGH). Methods: This was a single-center, prospective, descriptive cohort study conducted on 36 consecutive patients who underwent emergency CS at DGH from January 2024 to July 2025. Patients were stratified into ASA physical status categories I to III based on preoperative assessment. Data collected included demographics, CS indications, intraoperative complications (e.g., hemorrhage, hemodynamic instability), postoperative maternal outcomes (ICU admission, length of stay), and neonatal outcomes (Apgar scores, resuscitation needs). Statistical analysis used ANOVA and Chi-square tests, with p<0.05 considered significant. Results: The mean age was 28.5±5.2 years. The cohort comprised 13.9% ASA I, 61.1% ASA II, and 25.0% ASA III patients. Fetal distress (41.7%) was the leading indication, followed by severe pre-eclampsia/eclampsia (22.2%), which heavily drove the ASA III classification. A higher ASA score significantly correlated with worse outcomes. ASA III patients had a significantly longer mean hospital stay (8.5±2.8 days vs. 6.5±2.0 days for ASA II, p<0.05), higher incidence of hemodynamic instability (55.6% vs. 13.6% for ASA II, p<0.01), and were the only group requiring postoperative ICU admission (22.2%, p=0.03). Neonates of ASA III mothers had significantly lower 5-minute Apgar scores (6.8±1.6, p<0.01) and higher NICU admission rates (55.6%, p<0.01). Conclusion: The ASA physical status classification is a robust, practical