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The ARISCAT score is a promising model to predict postoperative pulmonary complications after major emergency abdominal surgery: an external validation in a Danish cohort

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Abstract

Purpose

Postoperative pulmonary complications (PPCs) occur in up to 30% of patients undergoing surgery and are a significant contributor to the overall risk of surgery. A preoperative risk prediction tool for postoperative pulmonary complications could succour clinical identification of patients at increased risk and support clinical decision making. This original study aimed to externally validate a risk model for predicting postoperative pulmonary complications (ARISCAT) in a cohort of patients undergoing major emergency abdominal surgery at a Danish University Hospital.

Methods

ARISCAT was validated prospectively in a cohort of patients undergoing major emergency abdominal surgery between March 2017 and January 2019. Predicted PPCs by ARISCAT were compared with observed PPCs. ARISCAT was validated with calibration, discrimination and accuracy and in adherence to the TRIPOD statement.

Results

The study included a total of 585 patients with a median age of 70 years. The majority of patients underwent emergency laparotomy without bowel resection. The predicted PPC frequency by ARISCAT was 24.9%, while the observed frequency of PPCs in the cohort was 36.1%. The slope of the calibration plot was 0.9546, the y axis interception was 0.1269 and the plot was well fitted to a linear slope. The Hosmer Lemeshow goodness-of-fit analysis showed good calibration (p > 0.25). ARISCAT showed good discrimination with AUC 0.83 (95% CI 0.79–0.86) on a receiver-operating characteristics curve and the accuracy was also good with a Brier score of 0.19.

Conclusions

ARISCAT was a promising tool to predict PPCs in a high-risk surgical population undergoing major emergency abdominal surgery.

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Availability of data and material

According to Danish law about data protection entire data material cannot be shared. However, if there are individual data material in relation to specific calculations the editors or reviewers request we will try our best to share that in a responsible and safe data protection manner.

Code availability

Not applicable.

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Funding

No funding received for this research.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark

    Dunja Kokotovic

  2. Department of Surgery, Zealand University Hospital, Køge, Denmark

    Thea Helene Degett, Sarah Ekeloef & Jakob Burcharth

  3. Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark

    Thea Helene Degett

Authors
  1. Dunja Kokotovic
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  2. Thea Helene Degett
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  3. Sarah Ekeloef
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  4. Jakob Burcharth
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Corresponding author

Correspondence to Dunja Kokotovic.

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Conflict of interest

All authors declare no conflicts of interest or compering interests.

Ethics approval

The study was approved by the Danish Data Protection agency (no: REG-042-2017). The study did not qualify for ethics approval by Danish law as no intervention was carried out.

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Kokotovic, D., Degett, T.H., Ekeloef, S. et al. The ARISCAT score is a promising model to predict postoperative pulmonary complications after major emergency abdominal surgery: an external validation in a Danish cohort. Eur J Trauma Emerg Surg 48, 3863–3867 (2022). https://doi.org/10.1007/s00068-021-01826-6

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  • DOI: https://doi.org/10.1007/s00068-021-01826-6

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