Over 1 million tonsillectomies with or without adenoidectomies (T ± As) are performed each year in the United States to treat sleep disordered breathing, obstructive sleep apnea, peritonsillar abscess, and chronic adenotonsillitis [1], [2], [3], [4], [5]. Post-operative complications include hemorrhage, infection and pain [6]. In fact, the risk of post-tonsillectomy hemorrhage increases with age and can reach up to 20 % in adults [7], [8]. Risk factors of hemorrhage are biological sex, smoking status, and perioperative non-steroidal ant-inflammatory drug administration [7]. Although T ± A is a common surgery, there are also risks of severe complications [9]. Studies have shown that adults undergoing tonsillectomies with or without adenoidectomies have higher complications such as pneumonia (27 %), urinary tract infections (27 %), and surgical site infections (16 %) [9], [10]. Additionally, T ± A procedures have been associated with higher rates of readmission and increased health care burden due to unanticipated scenarios [11].

Prior to undergoing any surgery requiring anesthesia, like a T ± A, patients are pre-operatively assigned an American Society of Anesthesiologists (ASA) Physical Status classification (ASA-PS) based on their health [12]. A designation of ASA Class I is indicated for healthy patients without underlying medical comorbidities. Patients with mild systemic disease are categorized as ASA Class II. ASA Class III includes patients with severe systemic disease, and ASA Class IV is classified for patients with severe systemic disease that is a constant threat to life. Patients classified as ASA III or IV require senior anesthesiologist consultation prior to surgery to determine perioperative management [12], [13].

For perioperative outcomes management, ASA Classification has long been established as a measure of fitness for a patient undergoing a surgical procedure. The ASA-PS offers clinicians a simple categorization of a patient's perioperative physiological status, however, it has limitations in serving as a direct indicator of operative risk and post-operative outcomes [14]. In addition, studies have shown that there are inconsistencies in the way anesthesiologists assign ASA classifications to patients; inconsistencies can arise from categorizing systemic diseases and factors such as obesity, anemia, and age [14]. Therefore, additional variables, such as patient demographics and a detailed history of the patient's preoperative comorbidities, should be considered when using the ASA-PS as a preoperative and postoperative risk assessment. Its original purpose was to create a homogenous stratifying system, and many studies have found that there is an independent correlation between ASA-PS classification and perioperative morbidity and mortality [15], [16], [17], [18], [19]. Due to the reliability noted in previous studies, this paper aims to assess whether ASA classification is a correlative measure for T ± A outcomes. Identifying correlations between the ASA-PS and post-operative complications will help create post-operative pathways and enable physicians to counsel patients on specific surgical outcomes.