Introduction: The ARISCAT index has been widely used in general&nonthoracic surgery however its use in thoracic surgery (TS) has not been widely studied.

Aim: To investigate the clinical efficiency of ARISCAT score index in predicting postoperative respiratory complications including respiratory failure in patients undergoing TS in a tertiary centre.

Materials and methods: Prospective risk assessment of pre-operative respiratory consultations to TS candidates with use of ARISCAT score and correlation with post-operative clinical outcomes.

Results: During 2020-2022,135 patients were referred for respiratory pre-op risk assesment prior to undergoing TS with curative intent. Comorbidities included hypertension 32%,coronary artery disease 11%,kidney disease 15%. Mean age 66.7 years (age range 39-95),75 males.Mean surgery duration 2.5hours.ARISCAT score was assessed as high in 62.9%(85/135) and associated with 42.1% risk of in-hospital post-operative complications that could potentially act as a deterrent factor to surgery. Following post-operative review only 4.7% (4/85) developed respiratory infection with subsequent respiratory failure that resolved with antibiotics and prolonged hospital stay by 4 days. The remaining patients were intermediate risk (13.3%) for post-op respiratory complications however none of them developed any.

Conclusions: ARISCAT overestimates post-op risk for respiratory complications mainly due to the duration of TS and patient age.It should not act per se as a deterrent factor for TS especially in tertiary thoracic centres where high volume and centralised expertise minimize potential risks.