Perioperative respiratory resource

Preoperative Pulmonary Risk & Optimization

A practical framework for using ARISCAT in context, recognizing concerns that need clinician assessment, and moving from risk identification to a coordinated perioperative respiratory plan.

This is not a self-clearance resource. It supports clinician-facing discussion and does not determine whether surgery should proceed, be delayed, or be canceled. Acute symptoms, unstable disease, or concerning oxygenation require direct clinical assessment.

A five-step workflow

Risk assessment should end in a plan

1. Establish the clinical baseline

Clarify symptoms, functional limitation, recent exacerbation or respiratory infection, oxygen requirement, known lung disease, sleep-disordered breathing, smoking exposure, relevant imaging, and the urgency/type of surgery.

2. Identify time-sensitive reasons to pause or escalate

Unstable respiratory symptoms, a suspected acute cardiopulmonary process, a recent infection with ongoing clinical impact, or unexplained resting hypoxemia needs clinician evaluation—not a score-only workflow.

3. Calculate validated scores without altering them

Use ARISCAT exactly as published when it applies. A score organizes known variables; it does not absorb every relevant risk factor or replace clinical judgment.

4. Address modifiable contributors with the perioperative team

Examples can include infection evaluation, anemia work-up, smoking intervention, optimization of diagnosed obstructive disease, medication review, OSA recognition, anesthesia planning, and postoperative pulmonary-care planning. The appropriate action and timing are patient- and procedure-specific.

5. Communicate a plan, not just a number

Share the score, its inputs, major factors outside the score, local protocol considerations, monitoring/escalation needs, and the responsible clinical team.

What ARISCAT does not capture

Important information remains outside the score

Patient context

Known pulmonary disease, OSA, smoking exposure, functional capacity, frailty, aspiration risk, and cardiac comorbidity can materially affect planning without changing the ARISCAT total.

Procedure and anesthetic context

Surgical approach, postoperative analgesia, fluid strategy, airway plan, anticipated ventilation, monitoring, and local recovery resources require team-specific decisions.

Trajectory and urgency

A stable chronic baseline differs from new or progressive dyspnea, a recent exacerbation, infection, or acute oxygenation change. The clinical trajectory may be more important than the score.

Evidence package

Sources for web, iOS, and Android

The complete formula, risk bands, limitations, review date, and machine-readable citations are maintained in a platform-neutral evidence file. Mobile implementations should show the same sources and guardrails rather than duplicating or simplifying them.

Open machine-readable ARISCAT evidence package

Canet et al. — ARISCAT derivation and validationThe original seven predictors: age, SpO₂, recent respiratory infection, anemia, surgical site, duration, and emergency surgery.Prediction models for postoperative pulmonary complications — systematic reviewA 2025 evidence synthesis reporting moderate pooled discrimination for ARISCAT and substantial limitations across many prediction models.Preoperative pulmonary risk evaluation and management reviewContext for structured preoperative respiratory assessment and risk scores.SASM guideline for preoperative OSA screeningPerioperative OSA screening context; the planned STOP-Bang tool will be kept separate from ARISCAT.Perioperative interventions for PPC preventionSystematic review of interventions; evidence and applicability vary by population and perioperative pathway.

What comes next in this cluster

The next companion will be a dedicated STOP-Bang and perioperative OSA resource. It will stay separate from ARISCAT because it screens for a different clinical question and should not be blended into an unvalidated composite score.