# Association Between ASA Physical Status Classification and Postoperative Intensive Care Requirement in Pediatric Patients Undergoing Dental Treatment Under General Anesthesia: A Retrospective Study

## TL;DR

This study shows that the ASA classification helps predict the need for intensive care in children after dental surgery under anesthesia.

## Contribution

The study demonstrates that ASA classification is a strong predictor of postoperative intensive care needs in pediatric dental patients.

## Key findings

- All patients needing intensive care were in ASA II or III groups, with no cases in ASA I.
- ASA classification was strongly associated with intensive care need (OR = 180.73, p < 0.001).
- Conditions like cerebral palsy and epilepsy increased intensive care risk (p < 0.001).

## Abstract

Background and aim: Accurate perioperative risk stratification is essential for patient safety in pediatric dental treatment under general anesthesia. We aim to evaluate the association between ASA (American Society of Anesthesiologists) Physical Status Classification and postoperative intensive care requirement in pediatric patients undergoing dental treatment under general anesthesia. Methods: In this retrospective study, the clinical records of 1003 children who underwent dental treatment under general anesthesia between June 2022 and June 2025 were evaluated. The patients’ age, gender, ASA classification, concomitant systemic diseases, and postoperative intensive care requirements were analyzed. The chi-square test and logistic regression analysis were used for statistical evaluation, and results are expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Results: The mean age of the patients was 5.78 ± 2.87 years, and 58.3% were male. All patients requiring postoperative intensive care were in the ASA II (34.7%) and ASA III (65.3%) groups, while no intensive care need was observed in the ASA I group (p < 0.001). The need for intensive care significantly increased, particularly in the presence of cerebral palsy, epilepsy, autism, congenital heart disease, and intellectual disability (p < 0.001). In addition, the mean age of children requiring intensive care was significantly higher (p < 0.001). In multivariable logistic regression analysis, ASA classification was significantly associated with postoperative intensive care requirement (OR = 180.73, 95% CI: 9.40–1922.49, p < 0.001), whereas age and gender were not independently associated. Furthermore, the interaction term between ASA and age (ASA × Age) was not statistically significant (p = 0.59). Conclusions: ASA classification was significantly associated with postoperative intensive care unit admission in pediatric patients undergoing dental treatment under general anesthesia and may contribute to perioperative risk assessment. The findings emphasize the need for early identification of high-risk children and support the integration of ASA classification into multidisciplinary preoperative planning to enhance patient safety and optimize postoperative resource utilization.