Key result
University-hospital practice is linked to ~5.9-fold higher odds of using preoperative pulmonary risk scores.
Why the study?
Structured risk scores are recommended to identify patients at risk of postoperative pulmonary complications, but their uptake among pulmonologists and pulmonary medicine residents is poorly characterised.
Cross-Sectional (n=202)
A survey of pulmonologists in Türkiye demonstrates that reported use of preoperative pulmonary risk scores relies almost entirely on the ARISCAT tool and is significantly higher among physicians in university/academic hospitals compared to state or private settings.
Practice setting differences may affect equitable preoperative risk assessment; leaves open whether increasing score use improves postoperative outcomes.
Purpose: Structured risk scores are recommended to identify patients at risk of postoperative pulmonary complications (PPCs), yet their uptake among the specialists who deliver preoperative respiratory consultation is poorly characterised. We examined reported score use, associated factors, and the barriers reported by non-users. Methods: We conducted a cross-sectional online survey using voluntary convenience sampling of pulmonologists and pulmonary medicine residents in Türkiye, recruited through professional channels (September 2025–March 2026). The primary outcome was self-reported use of scoring systems in preoperative assessment; naming at least one validated PPC prediction model (ARISCAT/Canet, Gupta, or Arozullah) was analysed as a post hoc secondary outcome. Associated factors were explored using multivariable logistic regression with categorical coding of institution and professional position, collinearity diagnostics, and sensitivity analyses. Reporting followed STROBE and CHERRIES. Results: Of 202 respondents, 154 (76.2%; 95% CI 69.8– 81.9) reported using scores and 142 (70.3%; 95% CI 63.5– 76.5) named a validated PPC model; 135 of these 142 (95.1%) named ARISCAT/Canet, whereas the Gupta and Arozullah models were each named by ≤ 8.9% of respondents. University-hospital practice was associated with higher odds of score use than state/private-hospital practice (adjusted OR 5.93; 95% CI 1.77– 19.94), and this association persisted in all sensitivity analyses. Residents and specialists did not differ after adjustment (OR 0.80; 95% CI 0.29– 2.21). Academic-rank physicians reported lower use than residents (OR 0.21; 95% CI 0.06– 0.78), but this exploratory finding was not robust to exclusion of internally inconsistent responses. Among the 38 consistent non-users, the most frequently reported barriers were limited assessment time (57.9%) and insufficient knowledge (26.3%). Conclusion: In this convenience sample, reported structured PPC risk assessment relied almost entirely on a single instrument and differed chiefly by institutional setting. These cross-sectional, self-reported findings suggest that education, workflow integration, and local comparative evaluation of candidate models merit prospective study.
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Olcay et al. (2026) conducted a cross-sectional in Preoperative pulmonary assessment (n=202). University-hospital practice vs. State/private-hospital practice was evaluated on Self-reported use of scoring systems in preoperative assessment (OR 5.93, 95% CI 1.77-19.94, p=0.004). University-hospital practice was associated with significantly higher odds of using structured preoperative pulmonary risk scores compared to state or private-hospital practice (adjusted OR 5.93).
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