The ARISCAT Risk Index as a Predictor of Pulmonary Complications After Thoracic Surgeries, Almoosa Specialist Hospital, Saudi Arabia

Figures & data

Table 1 Parameters of the ARISCAT Score and Risk Classification

Score Components		Risk Score
Age	≤50 year	0
	51–80 year	3
	>80 year	16
Preoperative oxygen saturation	≥96%	0
	91–95%	8
	≤ 90%	24
Respiratory infection in past 1 month	No	0
	Yes	17
Preoperative hemoglobin < 10g/dl	No	0
	Yes	11
Incision	Peripheral incision	0
	Upper abdominal incision	15
	Intrathoracic incision	24
Surgery duration	<2 hours	0
	2–3 hours	16
	>3 hours	23
Emergency procedure	No	0
	Yes	8
Risk	ARISCAT Score
Low	< 26 (1.6%)
Medium/Intermediate	26–44 (13.3%)
High	≥ 45 (42.1%)

Table 2 General and Clinical Characteristics of the Studied Patients

Variables		N = 108 (%)
Age (years)	Mean ± SD	42.5 ± 18.9
	Min – Max	3–80
Gender	Male	73 (67.6)
	Female	35 (32.4)
Comorbidities ^a		58 (53.7)
FEV1% (n=58)	Mean ± SD	71.1 ± 7.3
	Min – Max	50–80
ARISCAT score	Mean ± SD	39.3 ± 12.4
	Min – Max	24–76
ARISCAT grade	Low (<26)	20 (18.5)
	Medium (26–44)	50 (46.3)
	High (> 45)	38 (35.2)

Notes: ^aSome patients had more than one comorbid condition.

Abbreviations: DM, diabetes mellitus (27 patients); HTN, hypertension (23 patients); COPD, chronic obstructive pulmonary diseases (8 patients); IHD, ischemic heart diseases (four patients); SLE, systemic lupus erythematosus (three patients), Cardiomyopathy, Dyslipidemia; ESRD, end-stage renal disease; MG, myasthenia gravis, and Cancer colon (two patients each), Bronchopneumonia, Asthma, Mediastinal lesion, Pulmonary nodules, Right apical shadow, Pectus excavatum, Hypercoagulable state, Depression, Anxiety; CVA, cerebrovascular accident; CAD, coronary artery disease; SCD, Sickle cell disease; Post PCI, percutaneous coronary intervention, Past history of breast cancer (one patient each); FEV1%, forced expiratory volume.

Table 3 Type of Surgery for the Studied Patients

Type of Surgery	n=108 (%)
Thoracotomy	51 (47.2)
Video-assisted thoracoscopic surgery (VATS)	31 (28.7)
Mediastinoscopy	19 (17.6)
Mediastinotomy	2 (1.9)
Tracheostomy	1 (0.9)
Sternotomy	1 (0.9)
Neck incision	1 (0.9)
Right cervical incision	1 (0.9)
Anterior chest wall incision	1 (0.9)

Figure 1 Site of surgery for the study patients.

Table 4 Outcomes of Surgery Among the Studied Patients

Outcomes		n=108 (%)
ICU stay (days) (n=95)	Mean ± SD	1.76 ± 1.07
	Min–Max	1–7
Ward stay (days) (n=105)	Mean ± SD	3.16 ± 2.1
	Min–Max	1–15
Chest tube removal (days) (n=82)^a	Mean ± SD	3.78 ± 2.63
	Min–Max	1–16
Post-operative complications (n = 22)		22 (20.4)
Pneumonia		5 (4.6)
Atelectasis		5 (4.6)
Phrenic and/or laryngeal nerves injury		4 (3.7)
Wound infection		2 (1.9)
Difficult extubation		2 (1.9)
Bronchopleural fistula		1 (0.9)
Hemothorax		1 (0.9)
Surgical emphysema		1 (0.9)
Acute exacerbation of ILD		1 (0.9)
Management (n=16)		16 (14.8)
Systemic antibiotic		6 (5.6)
Wound care		4 (3.7)
Supportive treatment		3 (2.8)
Systemic steroids		2 (1.9)
Noninvasive ventilation		1 (0.9)

Notes: ^aIncludes patients managed by thoracotomy and VATS.

Abbreviation: ILD, interstitial lung disease.

Table 5 Association of Different Study Variables as Risk Factors for Post-Operative Complications

Variables		Post-Operative Complications		Univariate Analysis		Multivariate Analysis
		Yes (n=22)	No (n=86)	OR [95% CI]	P-value	OR [95% CI]	P-value
Age (years)		44.5 ± 13.3	43.3 ± 20.0	1.0 [0.98–1.03]	0.809
FEV1%		65.4 ± 8.6	72.6 ± 6.2	1.14 [1.14–1.26]	0.008*	0.88 [0.79–0.98]	0.017*
Gender	Male	17 (23.3)	56 (76.7)	1.82 [0.61–5.42]	0.319
	Female	5 (14.3)	30 (85.7)	1
Comorbidities		12 (54.5)	46 (53.5)	1.04 [0.41–2.67]	1.000
ICU stay (days)		2.31 ± 1.28	1.62 ± 1.23	1.24 [0.65–1.95]	0.031*	1.53 [1.04–2.25]	0.033*
Ward stay (days)		3.36 ± 2.2	2.06 ± 0.7	2.25 [0.76–6.62]	0.018*	1.17 [0.96–1.42]	0.125
Chest tube removal (days)		4.17 ± 3.18	3.67 ± 2.47	1.07 [0.89–1.28]	0.485
ARISCAT score		42.8 ± 10.7	38.4 ± 12.7	0.88 [0.80–0.97]	0.013*	1.22 [1.02–1.47]	0.040*
ARISCAT grade	Low	2 (9.1)	18 (20.9)	1	0.355
	Medium	8 (36.4)	42 (48.8)	0.60 [0.23–1.57]	0.344
	High	12 (54.5)	26 (30.2)	2.77 [1.06–7.21]	0.045*	2.77 [1.06–7.21]	0.037*
Site of surgery	Right	8 (36.4)	38 (44.2)	0.72 [0.27–1.90]	0.631
	Left	10 (45.5)	25 (29.1)	2.03 [0.78–5.31]	0.201
	Bilateral	0 (0.0)	2 (2.3)	1.26 [1.15–1.39]	1.000
	Localized	4 (18.2)	21 (24.4)	1	0.777
Type of surgery	Thoracotomy	15 (68.2)	36 (41.9)	2.98 [1.10–8.04]	0.032*	1.41 [0.22–9.10]	0.721
	VATS	3 (13.6)	28 (32.6)	0.33 [0.09–1.20]	0.113
	Mediastinoscopy	2 (9.1)	17 (19.7)	0.41 [0.09–1.91]	0.352
	Other incisions	2 (9.1)	5 (5.8)	1	0.629

Notes: Values present as number (%) or as mean ± SD. *Significant.

Abbreviations: OR, odds ratio; CI, confidence interval.