ARISCAT Score for Predicting Postoperative Pulmonary Complications
The ARISCAT score is a validated tool for predicting postoperative pulmonary complications (PPCs) in patients undergoing noncardiac surgery, though its performance varies by population and surgical context, with strongest validation in emergency abdominal surgery. 1, 2
What the ARISCAT Score Measures
The ARISCAT (Assess Respiratory Risk in Surgical Patients in Catalonia) score stratifies patients into risk categories for developing PPCs, which include atelectasis, pneumonia, respiratory failure, and exacerbation of chronic lung disease occurring within 30 days postoperatively. 3, 4
Performance in Different Populations
Strong Evidence Supporting ARISCAT:
Emergency abdominal surgery: ARISCAT demonstrated excellent discrimination with AUC 0.83 (95% CI 0.79-0.86) in patients undergoing major emergency abdominal surgery, with good calibration (Hosmer-Lemeshow p>0.25). 2
General noncardiac surgery: A prospective study of 1,170 patients found that intermediate and high-risk ARISCAT scores were independent predictors of PPCs, with 5% overall PPC incidence. 1
Elderly patients undergoing major abdominal surgery: ARISCAT (AUC=0.81) performed comparably to the modified Frailty Index (AUC=0.90) and better than ASA classification (AUC=0.69), with a cut-off score ≥27 providing 90.91% sensitivity and 51.16% specificity. 5
Limitations of ARISCAT:
Recent Indian validation study failure: In a 2025 retrospective study of 501 laparotomy patients, ARISCAT showed poor discrimination (AUC 0.567,95% CI 0.5-0.7) and failed goodness-of-fit testing (p=0.0001), suggesting limited utility in certain institutional settings. 6
Comparison to ASA score: In upper abdominal surgery patients, the ASA score demonstrated better predictive power than ARISCAT, though both had limited clinical significance. 4
Alternative Risk Assessment Approach
The American College of Physicians recommends clinical risk factor assessment rather than relying solely on prediction scores. 7
Key Patient-Related Risk Factors to Assess:
- Chronic obstructive pulmonary disease (OR 1.79,95% CI 1.44-2.22) 3
- Age >60 years (OR 2.09 for ages 60-69; OR 3.04 for ages 70-79) 3
- ASA class ≥II (OR 4.87) 3
- Functional dependence (OR 2.51 for total dependence; OR 1.65 for partial dependence) 3
- Congestive heart failure (OR 2.93) 3
- Low serum albumin <35 g/L 3
Procedure-Related Risk Factors:
- Prolonged surgery >3 hours (OR 2.14) 3, 4
- Emergency surgery (OR 4.47) 3
- Upper abdominal, thoracic, neurosurgery, head/neck, vascular, or aortic aneurysm repair 3
Clinical Application Algorithm
For patients with cardiovascular disease or diabetes undergoing noncardiac surgery:
Assess all patient-related risk factors listed above rather than relying on a single prediction score. 7
If considering ARISCAT, recognize it performs best in emergency abdominal surgery settings but may have limited utility in other populations. 6, 2
Measure serum albumin in all patients with ≥1 risk factor for PPCs. 3
Do NOT routinely order preoperative spirometry or chest radiography for risk prediction, though these may be appropriate for patients with known COPD or asthma. 7, 3
Critical Pitfall
The major pitfall is over-reliance on any single prediction tool. The evidence shows ARISCAT's performance is context-dependent and may fail in certain populations. 6 The American College of Physicians' clinical risk factor approach provides more consistent guidance across diverse surgical populations. 7
Prevention Strategies for High-Risk Patients
All patients identified as high-risk MUST receive:
- Deep breathing exercises or incentive spirometry (hourly while awake, 30 deep breaths per hour) 3, 8
- Early mobilization 8
- Selective (not routine) nasogastric tube use (only for postoperative nausea/vomiting, inability to tolerate oral intake, or symptomatic abdominal distention) 3, 8
- Supported coughing with incision splinting 8
For patients with COPD undergoing high-risk procedures like aortic aneurysm repair, preoperative inspiratory muscle training as part of multimodal prehabilitation is recommended by the European Respiratory Society. 3, 9