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

Completed

• Conditions: Atelectasis; Cancer; Pulmonary Complication; Postoperative Complications; Abdominal Surgery; Pneumonia

• Registration Number: NCT04663958
• Lead Sponsor: Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital

Brief Summary

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

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.

Study Timeline

• Study First Submitted: 2020-11-24
• Study First Submitted QC: 2020-12-05
• Study First Posted: 2020-12-11
• Study Start: 2020-12-21
• Primary Completion: 2021-06-18
• Study Completion: 2021-08-18
• Status Verified: 2022-11
• Last Update Submitted: 2022-11-16
• Last Update Posted: 2022-11-18

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 410

Inclusion Criteria

1. Over 18 years of age
2. Who were scheduled for general anesthesia
3. Whose ASA physical score was 1-4

Exclusion Criteria

1. ASA physical status> 4
2. Pregnant women
3. Intubated patients before the operation
4. Patients who had surgery due to a previous surgical complication
5. Severe cardiovascular disease
6. Severe hemodynamic instability

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Effectiveness of the ARISCAT risk scoring index	postoperative first 7 days	to investigate the effectiveness of the ARISCAT risk scoring index in predicting the development of PPC in patients undergoing major abdominal cancer surgery

Secondary Outcome Measures

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

Trial Locations

Locations (1)

Dr. Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital Clinic of Anesthesiology and Reanimation; 🇹🇷 Ankara, Yenimahalle, Turkey