Prediction of pulmonary complications following spine surgery: The ASA and ARISCAT risk indexes

Ayşe Neslihan Balkaya 1 * , Asiye Demirel 1
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1 Department of Anesthesiology and Reanimation, Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
* Corresponding Author
J CLIN MED KAZ, In press.
OPEN ACCESS

ABSTRACT

Objective: We aimed to evaluate the effectiveness of predicting postoperative pulmonary complications (PPCs) following spine surgery, comparing American Society of Anesthesiologist (ASA) and Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk scoring systems.
Material and methods: We reviewed 377 patients aged≥18 years who had undergone vertebral surgery. Demographic data, comorbidities, ASA classification, body mass index, ARISCAT risk score, pulmonary complications developing with in the postoperative 1st month were assessed.
Results: A total of 377 patients, 221 (58.6%) women and 156 (41.4%) men, mean age of 59±11.8 years were evaluated. Out of the 377 patients, 73 (19.4%) patients were ASA I, 235 (62.3%) patients were ASA II, 69 (18.3%) patients were ASA III, and the mean ARISCAT score was 22.51±8.38. In the postoperative period, PPC was identified in 30 (8%) patients, with atelectasis in 15 (4%), pneumothorax in 4 (1.1%), pneumonia in 4 (1.1%), respiratory failure in 4 (1.1%), bronchospasm in 2 (0.5%) patients, and pulmonary embolism in 1 (0.3%) patient. There was a statistically significant correlation between the presence of PPC and ASA score, and between the presence of PPC and the ARISCAT levels (p=0.000, p=0.000). The incidence of PPC increased with increasing ASA scores. The ARISCAT scores were higher in patients who developed PPC. The hospital stay of patients with PPCs were longer than other patients (p=0.000).
Conclusion: In our study, in which ASA classification and ARISCAT risk index were compared as a means to predict PPC, both scores were found to be effective.

CITATION

Balkaya AN, Demirel A. Prediction of pulmonary complications following spine surgery: The ASA and ARISCAT risk indexes. J Clin Med Kaz. 2022.

REFERENCES

  • Smetana GW: Preoperative pulmonary evaluation. N Engl J Med. 1999; 340:937–944. https://doi.org/10.1056/NEJM199903253401207
  • Fisher BW, Majumdar SR, McAlister FA. Predicting pulmonary complications after nonthoracic surgery: A systematic review of blinded studies. Am J Med. 2002; 112:219–225. https://doi.org/10.1016/s0002-9343(01)01082-8
  • Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144(8):581. https://doi.org/10.7326/0003-4819-144-8-200604180-00009
  • 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. https://doi.org/10.1093/bja/aeu100
  • 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. https://doi.org/10.6002/ect.mesot2016.P89
  • Mathiesen O, Dahl B, Thomsen BA, Kitter B, Sonne N, Dahl JB et al. A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery. Eur Spine J. 2013;22:2089-2096. https://doi.org/10.1007/s00586-013-2826-1
  • Carratala J, Fernandez-Sabe N, Ortega L, Castellsague X, Roson B, Dorca J, et al. Outpatient care compared with hospitalization for community-acquired pneumonia: a randomized trial in low-risk patients. Ann Intern Med. 2005;142:165–172. https://doi.org/10.7326/0003-4819-142-3-200502010-00006
  • Tilak KM, Litake MM, Shingada KV. Study of risk, incidence and mortality associated with postoperative pulmonary complications using assess respiratory risk in surgical patients in catalonia score. Int Surg J. 2019;6(9):3215-3222. https://doi.org/10.18203/2349-2902.isj20194054
  • Patel K, Hadian F, Ali A, Broadley G, Evans K, Horder C, et al. Postoperative pulmonary complications following major elective abdominal surgery: A cohort study. Perioper Med (Lond). 2016;5:10. https://doi.org/10.1186/s13741-016-0037-0
  • Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113:1338-1350. https://doi.org/10.1097/ALN.0b013e3181fc6e0a
  • Mazo V, Sabaté S, Canet J, Gallart L, de Abreu MG, Belda J, et al. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology. 2014;121:219-31. https://doi.org/10.1097/ALN.0000000000000334
  • Imposti F, Cizik A, Bransford R, Bellabarba C, Lee MJ. Risk factors for pulmonary complications after spine surgery. Evid Based Spine Care J. 2010;1(2):26-33. https://doi.org/10.1055/s-0028-1100911
  • Weinberg DS, Hedges BZ, Belding JE, Moore TA, Vallier HA. Risk factors for pulmonary complication following fixation of spine fractures. Spine J. 2017;17(10):1449-1456. https://doi.org/10.1016/j.spinee.2017.05.008
  • Balci A, Usame R, Akın C. Preoperative pulmonary evaluation and evaluation of postoperative pulmonary complications in geriatric patients undergoing spinal surgery. JHMN. 2020; 78:27-35.
  • Stundner O, Taher F, Pawar A, Memtsoudis SG. Pulmonary complications after spine surgery. World J Orthop. 2012;3(10):156-161. https://doi.org/10.5312/wjo.v3.i10.156
  • Gupta S, Fernandes RJ, Rao JS, Dhanpal R. Perioperative risk factors for pulmonary complications after non-cardiac surgery. J Anaesthesiol Clin Pharmacol. 2020;36(1):88-93. https://doi.org/10.4103/joacp.JOACP_54_19
  • Mazo V, Sabaté S, Canet J, Gallart L, de Abreu MG, Belda J, Langeron O, Hoeft A, Pelosi P. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology. 2014(8);121(2):219-31. https://doi.org/10.1097/ALN.0000000000000334
  • Kara S, Küpeli E, Yılmaz HEB, Yabanoglu H. Predicting pulmonary complications following upper and lower abdominal surgery: ASA, ARISCAT risk index. Turk J Anaesthesiol Reanim. 2020;48(2):96-101. https://doi.org/10.5152/TJAR.2019.28158
  • 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. https://doi.org/10.1093/bja/77.2.217
  • Daley J, Khuri SF, Henderson W, Hur K, Gibbs JO, Barbour G, et al. Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg. 1997;185:328–340. https://doi.org/10.1016/S1072-7515(97)00090-2
  • Mak PH, Campbell RC, Irwin MG. The ASA Physical Status Classification: inter-observer consistency. Anaesth Intensive Care. 2002;30:633–640. https://doi.org/10.1177/0310057X0203000516
  • Aronson WL, McAuliffe MS, Miller K. Variability in the American Society of Anesthesiologists Physical Status classification scale. AANA J. 2003;71:265–274.
  • Erbesler Z. Comparison of Markers for Prediction of Postoperative Pulmonary Complications; ASA and ARİSCAT. Ahi Evran Med J. 2021; 5(1): 50-54. https://doi.org/10.46332/aemj.787569
  • Mitchell CK, Smoger SH, Pfeifer MP, Vogel RL, Pandit MK, Donnelly PJ, et al. Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery. Arch Surg. 1998;133(2):194–198. https://doi.org/10.1001/archsurg.133.2.194
  • Hall JC, Tarala RA, Hall JL, Mander JA. Multivariate analysis of the risk of pulmonary complications after laparotomy. Chest. 1991;99923-927. https://doi.org/10.1378/chest.99.4.923
  • Fernandez-Bustamante A, Frendl G, Sprung J, Kor DJ, Subramaniam B, Martinez Ruiz R, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: A multicenter study by the perioperative research network investigators. JAMA Surg. 2017;152:157-166. https://doi.org/10.1001/jamasurg.2016.4065
  • Canet J, Gallart L. Predicting postoperative pulmonary complications in the general population. Curr Opin Anaesthesiol. 2013(4);26(2):107-115. https://doi.org/10.1097/ACO.0b013e32835e8acd
  • Musallam KM, Tamim HM, Richards T, Spahn DR, Rosendaal FR, Habbal A, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011(10) 15;378(9800):1396-407. https://doi.org/10.1016/S0140-6736(11)61381-0
  • McAlister FA, Khan NA, Straus SE, Papaioakim M, Fisher BW, Majumdar SR, et al. Accuracy of the preoperative assessment in predicting pulmonary risk after nonthoracic surgery. Am J Respir Crit Care Med. 2003;167(5):741-744. https://doi.org/10.1164/rccm.200209-985BC
  • Qaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW, et al. Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med. 2006 (4);144(8):575-580. https://doi.org/10.7326/0003-4819-144-8-200604180-00008
  • Sento Y, Suzuki T, Suzuki Y, Scott DA, Sobue K. The past, present and future of the postanesthesia care unit (PACU) in Japan. J Anesth. 2017(31); 601–607. https://doi.org/10.6002/ect.mesot2016.P89