Objective:

To evaluate whether assigning higher ASA-PS classifications based solely on a BMI ≥ 40 kg/m2 accurately reflects peri-operative risk for patients undergoing metabolic surgery, specifically in terms of their metabolic health status.

Key Findings:

• Higher ASA-PS scores were often assigned to patients with obesity prior to the 2014 update, potentially on subjective grounds.
• Obesity-related complications are significant for metabolic surgery indications, but BMI alone does not accurately predict peri-operative risks.
• Patients with metabolically healthy obesity may not exhibit the same peri-operative risks as those with metabolically unhealthy obesity, indicating a need for nuanced risk assessment.

Interpretation:

The study suggests that the ASA-PS classification based solely on BMI ≥ 40 kg/m2 may not effectively stratify peri-operative risk, as it does not account for the metabolic health status of patients, which is crucial for accurate risk assessment.

Limitations:

• Lack of differentiation between patients with and without chronic cardiac or metabolic diseases limits the applicability of findings.
• Absence of investigation into the specific impact of BMI ≥ 40 kg/m2 on peri-operative complications restricts understanding of its role in risk stratification.

Conclusion:

The findings indicate that ASA-PS III classification based solely on BMI ≥ 40 kg/m2 may not contribute meaningfully to peri-operative risk stratification in metabolic surgery, highlighting the need for a more comprehensive assessment approach.