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Combining Spirometry and the ARISCAT Respiratory Risk Assessment Can Improve Postoperative Outcomes and Reduce
Yolanda Mares-Gutiérrez1,2, Adrián Martínez-González3, Guillermo Salinas-Escudero4
1Pulmonary Physiology Department, Hospital General de México Dr. Eduardo Liceaga, C.P. 06720 Mexico City, Mexico.
Introduction:
Although a major goal of preoperative evaluation is to identify risk factors and improve postoperative outcomes, current clinical guidelines in Mexico indicate that preoperative spirometry should only be performed on patients with pulmonary disease. The aim of this study was to compare the incidence of postoperative complications (POC), mortality, and risk factors among adults who did or did not undergo preoperative spirometry, based on their Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk level.
Material And Methods:
An observational, retrospective and comparative study design was used to identify 2059 patients from the General Hospital of Mexico who had an ARISCAT assessment during 2013-2017. Patients were classified in two groups: ARISCAT with spirometry (n = 1306) and ARISCAT without spirometry (n = 753). Chi-square, Fisher's exact test and the Student's t-tests were used to compare groups. Logistic regression was used to identify factors associated with an increased risk of POC and mortality.
Results:
In the ARISCAT with spirometry group, 11% of patients had POC, compared with 48% of patients in the ARISCAT without spirometry group. High-risk ARISCAT patients who did not receive spirometry had higher mortality (18%), than those who underwent spirometry (0.4%). Logistic regression results indicate that not performing preoperative spirometry increases the probability of POC and mortality.
Conclusions:
Our findings suggest that the combined use of preoperative spirometry and ARISCAT is associated with reduced POC and mortality. Future clinical guidelines should recommend the use of preoperative spirometry for patients with a moderate or high ARISCAT level in Mexico.
Insights
Preoperative spirometry, combined with the ARISCAT risk assessment, significantly reduces postoperative complications and mortality in surgical patients. Guidelines should include spirometry for moderate to high-risk individuals.
Area of Science:
- Anesthesiology
- Pulmonology
- Surgical Risk Assessment
Background:
- Current Mexican guidelines limit preoperative spirometry to patients with known pulmonary disease.
- Preoperative evaluation aims to identify risks and improve surgical outcomes.
- The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) tool stratifies surgical risk.
Purpose of the Study:
- To compare postoperative complications (POC), mortality, and risk factors in patients who did or did not undergo preoperative spirometry.
- To evaluate the impact of spirometry based on ARISCAT risk levels.
Main Methods:
- Observational, retrospective, comparative study of 2059 patients (2013-2017) at the General Hospital of Mexico.
- Patients categorized into ARISCAT with spirometry (n=1306) and ARISCAT without spirometry (n=753) groups.
- Statistical analyses included Chi-square, Fisher's exact test, Student's t-tests, and logistic regression.
Main Results:
- The spirometry group had 11% POC versus 48% in the non-spirometry group.
- High-risk patients without spirometry had 18% mortality, compared to 0.4% with spirometry.
- Logistic regression confirmed that omitting spirometry increased POC and mortality risk.
Conclusions:
- Combining preoperative spirometry with ARISCAT assessment is linked to lower POC and mortality.
- Clinical guidelines in Mexico should consider recommending preoperative spirometry for moderate and high-risk ARISCAT patients.
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