Comparison of Markers for Prediction of Postoperative Pulmonary Complications; Asa and Ariscat

Abstract

Purpose: Pulmonary complications are important causes of morbidity and mortality that may occur after surgery. The aim of this study is to investigate the predictive value of American Society of Anesthesiologist (ASA) and The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk scoring systems in determining the risk of pulmonary complications during the postoperative period.

Materials and Methods: After obtaining ethics committee approval, 246 patients who were undergone elective operations between April 2019 - October 2019 in Ahi Evran University Department of Orthopedics and Traumatology were enrolled in the study. Gender, age and ASA clinical classification of all cases were recorded. Concommittant systemic diseases and types of surgery were recorded. ARISCAT risk index of all patients was calculated. In addition, postoperative pulmonary complications (PPC) such as atelectasis,pneumonia and respiratory failure seen within 1 month postoperatively were recorded as well.

Results: PPC developed in 15 (6.09%) cases. If we compare ASA and ARISCAT risk scoring system, ARISCAT appears to be more effective to predict the risk of PPC, but no statistically significant difference was found.

Conclusion: Although ASA score can be used for evaluating health state of patients subjectively at preoperative period, ARISCAT risk index could also be used for prediction of postoperative pulmonary complications.

Keywords

• ASA
• ARISCAT
• preoperative evaluation

Postoperatif Pulmoner Komplikasyonların Öngörülmesinde Belirteç Karşılaştırılması; Asa ve Ariscat

Abstract

Giriş: Ameliyat sonrası gelişen pulmoner komplikasyonlar önemli bir morbidite ve mortalite nedenidir. Bu çalışmanın amacı; elektif ortopedik cerrahi geçiren hastalarda, preoperatif dönemde uygulanan American Society of Anesthesiologist (ASA) ve Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk skorlama sistemlerinin postoperatif pulmoner komplikasyonların (PPK) ortaya çıkmasını öngörmede etkinliğini araştırmaktır. 

Araçlar ve Yöntem: Etik kurul onayı alındıktan sonra Nisan 2019 - Ekim 2019 tarihleri arasında, Ahi Evran Üniversitesi Ortopedi ve Travmatoloji Kliniğinde opere edilmiş 246 elektif hasta çalışmaya alındı. Tüm hastaların cinsiyet, yaş, ASA klinik sınıflamaları, eşlik eden sistemik hastalıklar ve cerrahi türleri kaydedildi ve ARISCAT risk indekleri hesaplandı. Postoperatif 1. ayda PPK (atelektazi, pnömoni ve solunum yetersizliği) gelişen hastalar kaydedildi.

Bulgular: Toplam 15 (%6,09) olguda PPK gelişti. PPK gelişme riskinde ASA ve ARISCAT risk skorlama sistemi karşılaştırıldığında ARISCAT daha etkili gibi görünsede anlamlı fark bulunamadı.

Sonuç: ASA ölçeği preoperatif sağlık durumunu subjektif olarak tahmin etmek için yaygın olarak kullanılmaktadır. Çalışmamızda ARISCAT ölçeğinin PPK’ları saptamada ASA skoruna göre, istatistiki açıdan anlamlı farklılık yaratmadığını saptadık.

Keywords

• ASA
• ARİSCAT
• preoperatif değerlendirme

References

1. 1. Smetana GW. Preoperative pulmonary evaluation. N Engl J Med. 1999;340(12):937-944.
2. 2. Canet J, Gallart L, Gomar C, et al. ARISCAT Group. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6):1338-1350.
3. 3. DeLisser HM, Grippi MA. Perioperative respiratory considerations in the surgical patients. Fishman AP (ed). Pulmonary Diseases and Disorders. McGraw Hill;1998:619- 629.
4. 4. Saklad M. Grading of patients for surgical procedures. Anesthesiology. 1941;2(3):281-284.
5. 5. Vogt AW, Henson LC. Unindicated preoperative testing: ASA physical status and financial implications. J Clin Anesth. 1997;9(6):437-441.
6. 6. Dalton JE, Kurz A, Turan A, Mascha EJ, Sessler DI, Saager L. Development and validation of a risk quantification index for 30-day postoperative mortality and morbidity in noncardiac surgical patients. Anesthesiology. 2011;114(6):1336-1344. 7. Hightower CE, Riedel BJ, Feig BW, et al. A pilot study evaluating predictors of postoperative outcomes after major abdominal surgery: physiological capacity compared with the ASA physical status classification system. Br J Anaesth. 2010;104(4):465-471.
7. 8. Saraçoğlu A, Yavru A, Küçükgöncü S, et al. Predictive factors involved in development of postoperative pulmonary complications. Turk J Anaesthesiol Reanim. 2014;42(6):313-319.
8. 9. Kupeli E, Dedekarginoglu B, Ulubay G, Eyuboglu FO, Haberal M. American Society of Anesthesiologists Classification Versus ARISCAT Risk Index: Predicting Pulmonary Complications Following Renal Transplant. Exp Clin Transplant. 2017;1:208-213.

9. 10. Ferguson MK. Preoperative assessment of pulmonary risk. Chest. 1999;115(5):58-63.
10. 11. Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77(2):217-222.
11. 12. Hall JC, Tarala RA, Hall JL, Mander J. A multivariate analysis of the risk of pulmonary complications after laparotomy. Chest. 1991;99(4):923-927.
12. 13. Mitchell CK, Smoger SH, Pfeifer MP, et al. Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery. Arch Surg. 1998;133(2):194-198.
13. 14. Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978;49(4):239-243.
14. 15. Smetana GW, Lawrence VA, Cornell JE. American College of Physicians. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144(8):581-595.
15. 16. Haynes SR, Lawler PG. An assessment of the consistency of ASA physical status classification allocation. Anaesthesia. 1995;50(3):195-199.
16. 17. Mak PH, Campbell RC, Irwin MG. American Society of Anesthesiologists. The ASA physical status classification: inter-observer consistency. Anaesth Intens Care. 2002;30(5):633-640.
17. 18. Aronson WL, McAuliffe MS, Miller K. Variability in the American Society of Anesthesiologists Physical Status classification scale. AANA J. 2003;71(4):265-274.
18. 19. Sankar A, Johnson SR, Beattie WS, Tait G, Wijeysundera DN. Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. Br J Anaesth. 2014;113(3):424-432.