The role of right ventricular systolic pressure and ARISCAT score in perioperative pulmonary risk assessment

Background

Postoperative Pulmonary Complications (PPC) are a significant source of increased morbidity and mortality after surgical procedures. Measures to enhance 30-day PPC risk stratification are an area of significant clinical interest, and integrating common preoperative investigations, such as echocardiography, may enhance quantitative risk prediction when combined with clinical score-based systems, particularly for high-risk populations. The authors hypothesized that Right Ventricular Systolic Pressure (RVSP) would significantly enhance the predictive capabilities of the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score in the prediction of 30-day PPC in a Pulmonary Hypertension (PH) study cohort.

Methods

277 patients with the diagnosis of PH, ARISCAT score, and echocardiography-derived RVSP within 12-months of surgical procedure were analyzed. The primary endpoint was the 59-variable 30-day Agency for Healthcare Research and Quality PPC composite. Secondary endpoints included sub composites of Pneumonia (PNA), Respiratory Failure (RF), Pulmonary Aspiration (ASP) and thromboembolic Phenomenon (PE). Adjusted multivariable logistic regression models followed by Receiver Operating Characteristic Curves (ROC) and Area Under the Curve (AUC) analysis were employed to assess the prediction of 30-day PPC.

Results

Mean RVSP was 52.1 mmHg (±17.4). Overall PPC incidence was 29.9%, with RF (19.5%), PNA (12.3%), ASP (5.4%), and PE (3.6%) composites. Logistic regression showed no significant association between RVSP and PPC (Odds Ratio [OR = 1.01], p = 0.307). The ARISCAT score was associated with 30-day PPC risk (OR = 1.02, p = 0.037). Receiver Operating Characteristic (ROC) curve analysis revealed an Area Under the Curve (AUC) of 0.555 for RVSP alone, 0.575 for the ARISCAT score, and 0.591 for the combination of RVSP+ARISCAT for the primary endpoint.

Conclusion

RVSP demonstrated limited efficacy as a standalone predictor of 30-day PPC in patients with PH. Although integrating RVSP with ARISCAT scoring yielded marginal improvements in predictive accuracy, neither metric, independently or in combination, achieved adequate clinical significance for reliable risk stratification. These findings highlight a critical gap in the current preoperative risk assessment for PH-specific predictive tools. Future research should focus on alternative measures that better capture vulnerability to the hemodynamic complexities underscoring PPC in this high-risk population.