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CLINICIAN REFERENCE

ARISCAT

ARISCAT estimates the risk of postoperative pulmonary complications (PPCs) after surgery under general or regional anaesthesia. It was derived in a Catalan surgical cohort and externally validated in a larger European cohort.

Score components

Variables include age, preoperative oxygen saturation, respiratory infection within the previous month, preoperative anaemia, surgical incision, duration of surgery and emergency status.

  • Age 51–80: 3 points. Age >80: 16 points.
  • SpO2 91–95%: 8 points. SpO2 ≤90%: 24 points.
  • Respiratory infection in previous month: 17 points
  • Haemoglobin ≤10 g/dL: 11 points
  • Upper abdominal incision: 15 points. Intrathoracic incision: 24 points.
  • Surgery 2–3 h: 16 points. Surgery >3 h: 23 points.
  • Emergency procedure: 8 points

Commonly used categories are low risk below 26, intermediate risk 26–44, and high risk 45 or above.

What counted as a complication

The derivation study used a composite outcome that included respiratory infection, respiratory failure, bronchospasm, atelectasis, pleural effusion, pneumothorax and aspiration pneumonitis. Event rates in each risk category differed between the derivation and validation cohorts, so category percentages should be quoted from the original papers with their population context.

Practical application

  • Four components are patient factors (age, SpO2, recent respiratory infection, anaemia). Three are procedural (incision site, duration, urgency). This separation can help identify which elements, if any, are modifiable before elective surgery.
  • Modifiable elements may include timing after a recent respiratory infection and optimisation of anaemia.
  • A higher score may inform discussion of anaesthetic technique, ventilation strategy, postoperative monitoring level, analgesia plan and respiratory physiotherapy. The evidence base for individual risk-reduction interventions varies.
  • Obstructive sleep apnoea, COPD severity and functional status are not ARISCAT variables but may still be clinically relevant.

The score was derived in a specific population and should complement, not replace, clinical judgement.

Sources