Predictive Value of Ariscat Index In The Development of Pulmonary Complication After Major Abdominal Cancer Surgery

Study Overview
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Brief Summary
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The term postoperative pulmonary complication is the development of any complications affecting the respiratory system after anesthetic and surgery procedures. The ARISCAT risk assessment score is a seven-variable regression model that divides patients into low, moderate, and high-risk groups. In this study, the investigators aimed to investigate the effectiveness of the ARISCAT risk scoring index in predicting postoperative pulmonary complication development in patients scheduled for major abdominal cancer surgery.

Detailed Description
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Postoperative pulmonary complications (PPC) are one of the major causes of postoperative morbidity and mortality. Mortality and morbidity are 14-30% in patients with PPC, while it is 0.2-3% in patients without PPC. Its incidence is variable (<1% to 19%) and is more common than cardiac complications. Unfortunately, PPCs prolong the hospital stay significantly (up to 13-17 days), which means postoperative delirium, infection, and cost increase. The causes of PPCs are varied, and their physiopathology is well explained [3]. However, the rate of risk identification and scoring is not known. The synergistic effects of the patient's medical condition, general anesthesia, and surgery type on the respiratory system complicate the problem.The surgical approach, anesthesia method, and preoperative risk factors of the patients play an important role in the development of PPC. This study was conducted after the approval from Dr. Abdurrahman Yurtaslan Oncology SUAM Ethics Committee in Ankara, Turkey (Between December 2020 - July 2021) (Ethics Committee Decision No: 2019-11 / 459). After informing all the patients included in the study, verbal and written consent were obtained. 410 patients over 18 years of age, who were scheduled for general anesthesia and whose ASA physical score was 1-4, were included in the study. Demographic data of the patients, preoperative antibiotic prophylaxis, chronic diseases, ASA scores, preoperative hemoglobulin values, functional status, history of pulmonary system disease in the last 30 days, history of smoking and the amount of cigarette consumption, history of steroid use, chemotherapy and radiotherapy history, anesthesia method, surgical incision side (lower-upper abdominal), premedication status, intraoperative ventilation parameters (tidal volume, PEEP, peak pressure, fiO2 ratio), pneumoperitoneum pressure, amount of colloid / crystalloid product used, erythrocyte suspension and amount used, laparoscopic or open surgery, emergency or elective surgery, the duration of operation, and postoperative analgesia method (such as intravenous or epidural patient-controlled analgesia) were recorded. The ARISCAT risk assessment scores of the patients were also evaluated and recorded preoperatively. The patients were followed up in the postoperative care unit. The presence of postoperative pulmonary complications was evaluated, and the time of discharge was recorded. On the 30th day after discharge, patients were called and checked their status in terms of mortality. Postoperative pulmonary complications were defined by the development of one of the following new findings. The European Perioperative Clinical Outcome Definitions (EPCO) were used for this definition. These findings; Respiratory Failure, Respiratory infection, Aspiration Pneumonia, Pleural effusion, Pneumothorax, Atelectasis, Bronchoconstriction, Pneumonia, ARDS, Pulmonary Embolism, Pulmonary Edema, Unplanned emergency re-intubation, Leaving as intubated from the operation room.

Official Title
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Predictive Value of Ariscat Risk Index In The Development of Postoperative Pulmonary Complication After Major Abdominal Cancer Surgery

Conditions
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Postoperative Complications, Cancer, Pulmonary Complication, Atelectasis, Abdominal Surgery, Pneumonia

Intervention / Treatment
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* Diagnostic Test: Detection / Screening


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Over 18 years of age Who were scheduled for general anesthesia Whose ASA physical score was 1-4 Exclusion Criteria: ASA physical status> 4 Pregnant women Intubated patients before the operation Patients who had surgery due to a previous surgical complication Severe cardiovascular disease Severe hemodynamic instability

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: Detection / Screening|The patients were followed up in the postoperative care unit. The presence of postoperative pulmonary complications was evaluated, and the time of discharge was recorded. On the 30th day after discharge, patients were called and checked their status in terms of mortality.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Effectiveness of the ARISCAT risk scoring index | to investigate the effectiveness of the ARISCAT risk scoring index in predicting the development of PPC in patients undergoing major abdominal cancer surgery | postoperative first 7 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation between age (years) and PPC | Whether there is a correlation between age (years) and PPC | postoperative first 30 days | 
| Correlation between gender(male or female) and PPC | Whether there is a correlation between gender (male or female) and PPC | postoperative first 30 days | 
| Correlation between BMI (kg/m^2) and PPC | Whether there is a correlation between BMI (kg/m^2) and PPC | postoperative first 30 days | 
| Correlation between history of smoking and the amount of cigarette consumption level (packs/year) and PPC | Whether there is a correlation between smoking level (packs/year) and PPC | postoperative first 30 days | 
| Correlation between ASA physical score (1-4) and PPC | Whether there is a correlation between ASA physical score (1-4) and PPC | postoperative first 30 days | 
| Correlation between Preoperative Sp02(>96%, 91%-95%, <90%) and PPC | Whether there is a correlation between Preoperative Sp02(>96%, 91%-95%, <90%) and PPC | postoperative first 30 days | 
| Correlation between preoperative hemoglobulin values (gram / deciliter) and PPC | Whether there is a correlation between preoperative hemoglobulin values (gram / deciliter) and PPC | postoperative first 30 days | 
| Correlation between surgical incision side (lower-upper abdominal) and PPC | Whether there is a correlation between surgical incision side (lower-upper abdominal) and PPC | postoperative first 30 days | 
| Correlation between laparoscopic or open surgery and PPC | Whether there is a correlation between laparoscopic or open surgery and PPC | postoperative first 30 days | 
| Correlation between , emergency or elective surgery and PPC | Whether there is a correlation between , emergency or elective surgery and PPC | postoperative first 30 days | 
| Correlation between the duration of operation (<2 hours, 2-3 hours, more than 3 hours) and PPC | Whether there is a correlation between the duration of operation (<2 hours, 2-3 hours, more than 3 hours) and PPC | postoperative first 30 days | 
| Correlation between postoperative analgesia method (such as intravenous or epidural patient-controlled analgesia) and PPC | Whether there is a correlation between postoperative analgesia method (such as intravenous or epidural patient-controlled analgesia) and PPC | postoperative first 30 days |