Concept of perioperative respiratory risk: a narrative review

I.B. Zabolotskikh, N.V. Trembach, S.A. Dryaev

Appendix 1. Main scales for predicting pulmonary complications

Scale/model Target outcome Variables When to use Limitations/conditions Reference
Arozullah PRF (NSQIP-VA) RF: reintubation or MV > 48 h Type of surgery; emergency status; albumin; blood urea nitrogen; FS; COPD; age Preoperative screening for RF risk and planning the level of postoperative monitoring/ICU care VA cohort predominantly male; possible loss of calibration; external validation required [44]
Gupta PRF (ACS-NSQIP) RF: MV > 48 h or unplanned intubation/reintubation (within 30 days) Type of surgery; emergency status; FS; preoperative sepsis; ASA class Preoperative decision-making regarding management and resource allocation (ICU/monitoring) Relies on registry-defined outcomes; local calibration assessment required [25]
PERISCOPE-PRF RF: hypoxemia/need for noninvasive or invasive ventilation Oxygen saturation; symptoms; HF; liver disease; surgical invasiveness; emergency status; duration Preoperative assessment of RF risk when data are limited Internal validation reported in the article; external validation is limited/required [49]
ARISCAT PPCs (composite of pulmonary complications) Oxygen saturation; URT infection; age; anemia; surgical approach; duration; emergency status General preoperative PPC risk screening and selection of preventive measures Historical cohort; composite definition depends on clinical practice; recalibration may be required [16]
LAS VEGAS risk score PPCs/RF (including need for supplemental oxygen, MV, or ARDS) 13 perioperative factors, including airway pressure and duration When intraoperative factors and ventilation parameters need to be considered Observational data; external validation required before widespread implementation [26]
SPORC-2 Early reintubation/need for MV (postoperative days 1–3) Variables not listed (pre- and intraoperative factors) Resource planning and monitoring during the first postoperative day Predicts severe early events rather than the full spectrum of PPCs [23]
LIPS (Lung Injury Prediction Score) Early risk of acute lung injury/ARDS Predisposing conditions + modifiers (sepsis/shock/aspiration, etc.) Early identification of patients at high risk of ARDS for preventive interventions Not exclusively perioperative; thresholds are population-dependent; external validation required [58]
STOP-Bang High risk of obstructive sleep apnea as a risk factor for complications Snoring; daytime sleepiness; observed apneas; BP; BMI; age; neck circumference; sex Preoperative screening and enhanced monitoring, opioid-sparing strategies, and CPAP Screening tool, not a diagnosis; moderate specificity; clinical context required [66]
Arozullah PN (VA) Postoperative pneumonia Type of surgery; age; FS; weight loss; COPD; impaired consciousness; stroke; blood urea nitrogen Preoperative prediction of pneumonia and targeted prevention Historical cohort predominantly male; transportability/calibration require evaluation [50]
Gupta PN (ACS-NSQIP) Pneumonia (within 30 days) Age; ASA class; COPD; FS; sepsis; smoking; type of surgery Preoperative stratification of pneumonia risk Depends on the registry definition of pneumonia; local calibration assessment required [51]
Russotto et al. model Postoperative pneumonia FS; oxygen saturation; colloids; blood transfusion; upper abdominal surgery Pneumonia risk stratification incorporating perioperative factors Further external validation is required, as stated in the article [52]
Kawasaki nomogram Postoperative pneumonia after major abdominal surgery Age; male sex; CVD; smoking index ≥ 900; surgical approach Individualized pneumonia risk assessment in abdominal surgery Internal validation reported; external validation not presented [53]
Note: ARDS — acute respiratory distress syndrome; ASA — American Society of Anesthesiologists Physical Status Classification; BMI — body mass index; BP — blood pressure; COPD — chronic obstructive pulmonary disease; CPAP — continuous positive airway pressure therapy; CVD — cerebrovascular disease; FS — functional status; HF — heart failure; ICU — intensive care unit; MV — mechanical ventilation; PPCs — postoperative pulmonary complications; RF — respiratory failure; URT — upper respiratory tract.