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March 3, 1989


JAMA. 1989;261(9):1277. doi:10.1001/jama.1989.03420090041015

To the Editor. —  I suppose you might be mildly annoyed to have your remarks attributed to the American Manufacturers Association. You will understand my annoyance at finding that your abstractor1 has invented the American Standards Association as the authority for classification of Physical Status, instead of the American Society of Anesthesiologists, as properly attributed by Gluck et al.2 Perhaps in calling their error to attention you will permit yet another correction. The ASA Physical Status is not an anesthetist's evaluation of risk but rather of global function. A patient with coronary artery disease would be assigned the same Physical Status for either a bunionectomy or bypass grafting. The risks of the operation obviously are different. The ASA Physical Status is a comprehensive and significant risk factor but so is the operation. Since sicker patients often require more dangerous surgery than healthy patients (a tautology I admit), Physical