Why use it

Identifies high-risk patients who need intensified respiratory monitoring, prophylactic physiotherapy, and selective use of lung-protective ventilation strategies. PPCs occur in 5–10% of non-cardiac surgeries and increase 30-day mortality 10-fold. ARISCAT is the only PPC risk score externally validated in a large multicenter European cohort.

About

The ARISCAT (Assess Respiratory RIsk in Surgical patients in CATalonia) score is a validated preoperative risk stratification tool for postoperative pulmonary complications (PPC) following non-cardiac surgery. PPCs include respiratory failure, respiratory infections (pneumonia, tracheobronchitis), pleural effusion, atelectasis, pneumothorax, and bronchospasm — and are the leading cause of postoperative morbidity and mortality. The ARISCAT score uses seven independent preoperative predictors (age, preoperative SpO₂, respiratory infection in the past month, preoperative anemia, surgical incision site, duration of surgery, and emergency procedure) to classify patients into three risk groups.

When to use

Preoperative risk assessment for any non-cardiac surgery patient
Planning perioperative respiratory management (physiotherapy, ventilation strategy, ICU admission)
Anesthesia pre-assessment clinics for intermediate and high-risk patients
Informed consent discussions about respiratory risks of surgery
Research case-mix adjustment for postoperative outcomes

Formula

ARISCAT Score = Sum of the following items: Age: <51 years=0, 51–80 years=+3, >80 years=+16 Preoperative SpO₂ (room air): ≥96%=0, 91–95%=+8, ≤90%=+24 Respiratory infection in last month: No=0, Yes=+17 Preoperative anemia (Hgb ≤10 g/dL): No=0, Yes=+11 Surgical incision site: Peripheral/superficial=0, Upper abdominal=+15, Intrathoracic=+24 Duration of surgery: <2 hours=0, 2–3 hours=+16, >3 hours=+23 Emergency procedure: No=0, Yes=+8 Risk Groups: Low: < 26 → ~1.6% PPC risk Intermediate: 26–44 → ~13.3% PPC risk High: ≥ 45 → ~42.1% PPC risk

Pearls & pitfalls

ARISCAT was derived from 2,464 patients across 59 hospitals in Spain (ARISCAT Group, Anesthesiology 2010).
SpO₂ < 90% at room air preoperatively scores the highest single weight (+24 points) — always obtain preoperative SpO₂.
Intrathoracic surgery carries the highest incision-site score (+24 points), reflecting direct pulmonary manipulation.
Duration of surgery > 3 hours doubles PPC risk compared to surgery < 2 hours.
Emergency procedures add 8 points, likely due to inadequate preoperative optimization.
Preoperative anemia (Hgb ≤ 10 g/dL) is an independent risk factor for PPCs (+11 points).
External validation in the PERISCOPE cohort (>6,000 patients, 28 European countries) confirmed ARISCAT performance with AUC 0.72.

Next steps

Low risk (ARISCAT < 26): Routine perioperative care. Intermediate risk (26–44): Intensified respiratory monitoring; consider preoperative physiotherapy; discuss lung-protective intraoperative ventilation. High risk (≥ 45): Highest risk of PPC (42%); consider preoperative optimization; plan ICU admission; mandatory lung-protective ventilation (tidal volume 6–8 mL/kg IBW, PEEP 5–8 cmH₂O); postoperative NIV if needed.

Evidence

Canet J et al. (Anesthesiology 2010) derived ARISCAT from 2,464 patients; PPC incidence 11.6%. AUC 0.90 for in-hospital PPC. Externally validated in PERISCOPE study (Mazo V et al., Anesthesiology 2014): 6,121 patients, 28 countries, AUC 0.72, confirmed three risk strata. Endorsed by the European Society of Anaesthesiology.

References

Canet J et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6):1338-1350. — link
Mazo V et al. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology. 2014;121(2):219-231. — link

ARISCAT Score for Postoperative Pulmonary Complications

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