Variation in ASA Scoring (Milestone-2)

Dear colleagues,

The society is supporting the MILESTONE-2 survey, an international collaboration of (HPB) surgeons and anesthesiologist in which we want to explore the reasons behind the large variations seen in the ASA classification in patients undergoing HPB surgery. To what extent is this actually related to patient factors? 

A previous study of our group found large differences in ASA scores in HPB surgery between different countries (USA vs European). For pancreatic surgery: ASA III/IV in NSQIP 78%, in Germany 48%, in the Netherlands 23%, and in Sweden only 3%. Since ASA is also utilized for case mix adjustment it is vital that consensus is reached on the practicalities of this system.