The study was done to assess the efficiency of Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score in predicting post-operative pulmonary complications (PPC) in esophagectomy patients at a tertiary cancer care hospital by retrospective analysis. We included patients belonging to ASA II and III categories who underwent esophagectomy at our institution during June 2016 to June 2017. Patients with missing data were excluded from analysis. The medical records of these patients were reviewed to obtain data. The seven-factors of ARISCAT score were recorded from the medical records. The occurrence of post-operative pulmonary complications and length of stay were also recorded from the medical records. Statistical analysis was done using SPSS software (version 11.0).  Fisher’s exact test, chi-square test, Logistic regression and Kaplan-Meier analysis were used. Among the study group 16 patients out of 19 belonging to the high risk ARISCAT category (84.2%) and 8 out of 24 patients (33.3%) of intermediate risk group had PPC (P =0.002). From the logistic regression analysis there is a ten times increased risk of PPC developing in patients falling in the high-risk category of ARISCAT than those in intermediate risk category (OR=10.667, 95%CI 2.387-47.659, P= 0.002). Pre-operative SpO₂, anaemia, respiratory infection in last month and age showed a positive correlation for development of PPC in the high-risk category compared with the intermediate risk category. ARISCAT risk score has a good practical applicability in pulmonary risk stratification of esophagectomy patients and should be explored further.

Keywords: Efficiency, Esophagectomy, Post-operative pulmonary, Retrospective Analysis, Surgical oncology, Thoracic surgery.

1. Fisher BW, Majumdar SR, McAlister FA. Predicting pulmonary complications after nonthoracic surgery: A systematic review of blinded studies. Am J Med.2002;112(3): 219-225.
2. Schieman C, Wigle DA, C Deschamps et al. Patterns of operative mortality following esophagectomy. Diseases of esophagus.2012:25(7);645-651.
3. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2018 Nov; 68(6): 394-424.
4. Canet J, Gallart L, Gomar C, Paluzie G et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 2010: 113;1338-1350.
5. Speicher P, Englum B, Ganapathi A et al. Traveling to a high-volume centre is associated with improved survival for patients with esophageal cancer. Annals of surgery. 2017:265(7); 743-749.
6. Metzger R, Bollschweiler E, Vallhohmer D et al. High-volume centres for esophagectomy: what is the number needed to achieve low postoperative mortality? Diseases of esophagus. 2004: 17(4);310-314.
7. Jammer IW, sander MN et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol 2015; 32: 88-105.
8. Complications of esophageal resection – Up To Date [Internet]. [Cited 2019 Feb 17]. Available from: https://www.uptodate.com/contents/complications-of-esophageal-resection.
9. Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest. 1997; 111(3): 564-571.
10. Smetana GW, Lawrence VA, Cornell JE; American College of Physicians. Preoperative pulmonary risk stratification for non-cardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144(8): 581-595.
11. Saager L, Turan A, Reynolds LF, Dalton JE, Mascha EJ, Kurz A. The association between preoperative anemia and 30-day mortality and morbidity in noncardiac surgical patients. Anesth Analg. 2013; 117 (4):909-915.
12. Musallam KM, Tamim HM, Richards T, et-al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011;378(9800):1396-1407.
13. Kupeli E, Er Dedekarginoglu B, Ulubay G, Haberal M et al. American Society of Anesthesologists classification versus ARISCAT risk index: Predicting pulmonary complications following renal transplant. Exp Clin Transplant. 2017; 15(1):208-213.

Rajasree Omanakutty Amma

Associate Professor, Department of Anaesthesiology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India