Comparison of predicting strenghts of postoperative pulmonary complication risk evaluation indices in patients with Chronic Obstructive Pulmonary Disease (COPD)

Purpose: The aim of this study was to evaluate the power of Ariscat-Canet Preoperative Pulmonary Complication Risk Index, Arozullah and Gupta Respiratory Failure Indices to predict postoperative pulmonary complications in preoperative patients with COPD (divided by GOLD class A, B, C and D) undergoing elective extra-thoracic surgery. Materials and Methods: The study was done at University of Manisa Celal Bayar, Hafsa Sultan Hospital and 100 patients with COPD that applied to pulmonology and surgery clinics were involved. One or two weeks before the operation medical history of patients was taken and physical examination, respiratory function tests was performed. Arterial blood gas analysis samples were taken and chest X-ray of each patients were evaluated. Patients were classified according GOLD criteria which included mMRC dyspnea score/CAT questionnaire and number of exacerbations in last year as A, B, C, D. Ariscat-Canet Preoperative Pulmonary Complication Risk Index, Arozullah and Gupta Respiratory Failure Indices were calculated. After the score was calculated, each patient was followed up after surgery for 72 hours to look for any development of respiratory complications. Symptoms were questioned and physical examination was performed after surgery. Arterial oxyhaemoglobin saturation measurements by using pulse oximetry were recorded, arterial blood gas analysis samples were taken and chest X-ray were performed if necessary. Pulmonary and extrapulmonary complications were recorded. Results: According to the results, 10% of patients had at least one respiratory complication and 5% had non-respiratory complication. Respiratory failure was the most common respiratory complication (20.3%). Most common extrapulmonary complication was infectious diseases. When the relationship between the demographic data and preoperative risk assessment indices of the patients was examined, it was seen that there was no correlation between the indices of mMRC score, CAT score, FEV1 value and COPD GOLD stage, but as the number of exacerbation episodes increased, the scores of the indices increased. Age, smoking (pack-year) history, BMI, mMRC and CAT scores did not increase the risk of postoperative complications, but higher GOLD class was found positively correlated with more complications. Ariscat-Canet risk index, which is one of these risk assessment indices, was found to be stronger in predicting complications than the other two indices. Our study has shown that Gupta and Arozullah Respiratory Failure Indices were unable to determine postoperative pulmonary risk adequately. Conclusion: Our study has shown that in patients with COPD, preoperative existence of respiratory symptoms and physical examination findings increases postoperative pulmonary complications. Preoperative risk assessment indices of COPD patients were found to be useful in predicting the risk of complications. Ariscat-Canet risk index, which is one of these risk assessment indices, was found to be stronger in predicting complications than the other two indices. It was concluded that the use of Ariscat-Canet risk index during the preoperative evaluation of COPD patients in daily practice may be beneficial. Keywords: Preoperative evaluation, COPD, Ariscat-Canet Risk Index, Arozullah Respiratory Failure Index, Gupta Respiratory Failure Index, postoperative complications