AI-Based ASA Classification in Preoperative Patients

Overview

This prospective observational study aims to evaluate the performance of multiple artificial intelligence-based large language models in assigning American Society of Anesthesiologists Physical Status (ASA-PS) classifications in adult preoperative patients. AI-generated ASA scores obtained using both prompted and unprompted clinical scenario inputs will be compared with assessments performed by experienced anesthesiologists. The agreement, accuracy, readability, and overall quality of AI outputs will be analyzed to determine the potential role of artificial intelligence in supporting preoperative risk stratification.

The American Society of Anesthesiologists Physical Status (ASA-PS) classification is widely used for perioperative risk stratification but is subject to interobserver variability. Recent advances in artificial intelligence and large language models have introduced new opportunities for clinical decision support. This prospective observational study includes adult patients undergoing routine preoperative anesthesia evaluation at Bursa City Hospital. Demographic data, medical history, comorbidities, functional capacity, laboratory findings, electrocardiography, chest imaging results, and planned surgical procedures are recorded to construct standardized clinical scenarios. Multiple artificial intelligence models, including large language model-based systems, are provided with patient scenarios using both structured prompts and unstructured inputs. Each model assigns an ASA-PS classification and provides explanatory text. AI-generated classifications are compared with assessments performed independently by experienced anesthesiologists. Primary outcomes include agreement and accuracy between AI-generated and clinician-assigned ASA classifications using Cohen's Kappa statistics. Secondary outcomes include readability assessment using the Ateşman Turkish Readability Index and response quality evaluation using the Global Quality Scale. The study aims to explore whether artificial intelligence can improve standardization, objectivity, and efficiency in preoperative risk assessment while highlighting the strengths and limitations of current AI technologies in clinical anesthesia practice.

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