: The purpose of the present study was to assess the duration of operative time and outcomes related to patients with an increased American Society of Anesthesiologists (ASA) Physical Status classification in the setting of hospital-based maxillofacial surgical procedures.

: A retrospective multi-institutional cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program database to enroll patients who underwent maxillofacial procedures between 2012 and 2019. The primary independent variable was ASA Physical Status Classification (I, II, III, IV). Descriptive, univariate, and multiple logistic regression statistics were utilized to evaluate the relationship between ASA Classification, body mass index (BMI), operative time, and perioperative complications.

: The study cohort was comprised of 1,807 subjects, with 946 males and 861 females. ASA Physical Status Classification ranged from Class I to IV. On bivariate analysis, patients classified as ASA III (286 [IQR 152-503], P<0.001) and ASA IV (412 [IQR 156.5-547.5], P=0.003) were associated with longer operative times. The risk of perioperative complications was 2.6% for ASA I patients (n=19), 6.3% for ASA II (n=48; P=0.005), 24.5% for ASA III (n=76; P<0.001), and 55.0% for ASA IV (n=11; P<0.001). On multivariate-adjusted analysis, using ASA I as the reference, ASA III (β +53.2 minutes, 95% Confidence Interval [CI] +28.6 to +77.8, P<0.001) and ASA IV (β +81.5 minutes, 95% Confidence Interval [CI] +21.0 to +141.9, P=0.008) were variables associated with longer operative time.

: Increased ASA Physical Status Classification was associated with increased operative time and perioperative complications.