%0 Journal Article %A Hussein J. Hassan %A Traci Housten %A Aparna Balasubramanian %A Catherine E. Simpson %A Rachel L. Damico %A Stephen C. Mathai %A Paul M. Hassoun %A Jochen Steppan %A Peter J. Leary %A Todd M. Kolb %T A novel approach to perioperative risk assessment for patients with pulmonary hypertension %D 2021 %R 10.1183/23120541.00257-2021 %J ERJ Open Research %P 00257-2021 %X Rationale Pulmonary hypertension (PH) is associated with significant perioperative morbidity and mortality. We hypothesized that pulmonary arterial hypertension (PAH) composite risk assessment scores could estimate perioperative risk for PH patients when adjusted for inherent procedural risk.Methods We identified patients in the Johns Hopkins PH Center Registry that had non-cardiac surgery (including endoscopies) between September 2015 and January 2020. We collected information on preoperative patient-level and procedural variables and used logistic regression to evaluate associations with a composite outcome of death within 30 days or serious post-operative complication. We generated composite patient-level risk assessment scores for each subject and used logistic regression to estimate the association with adverse surgical outcomes. We adjusted multivariable models for inherent procedural risk of major cardiovascular events, and used these models to generate a numerical PH perioperative risk (PHPR) score.Results Among 150 subjects, 19 (12.7%) reached the primary outcome including seven deaths (4.7%). Individual patient-level and procedural variables were associated with the primary outcome (all p<0.05). A composite patient-level risk assessment score built on three non-invasive parameters was strongly associated with reduced risk for poor outcomes (OR=0.4, p=0.03). This association was strengthened after adjusting the model for procedural risk. A PHPR score derived from the multivariable model stratified patients into low (0%), intermediate (≤10%), or high (>10%) risk of reaching the primary outcome.Conclusion Composite PAH risk assessment scores can predict perioperative risk for PH patients after accounting for inherent procedural risk. Validation of the PHPR score in a multi-center, prospective cohort is warranted.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. Hassan has nothing to disclose.Conflict of interest: Dr. Housten has nothing to disclose.Conflict of interest: Dr. Balasubramanian has nothing to disclose.Conflict of interest: Dr. Simpson has nothing to disclose.Conflict of interest: Dr. Damico has nothing to disclose.Conflict of interest: Dr. Mathai reports personal fees from Actelion, personal fees from Liquidia, personal fees from United Therapeutics, outside the submitted work, and Member, Rare Disease Advisory Panel, Patient Centered Outcomes Research Institute (PCORI).Conflict of interest: P.M. Hassoun serves on a scientific advisory board for MSD outside the submitted work.Conflict of interest: Dr. Steppan has nothing to disclose.Conflict of interest: Dr. Leary reports personal fees from Bayer, research support as a site PI for United Therapeutics and Actelion, and research grants from the American Heart Association, Pulmonary Hypertension Association, Chest Foundation, and NIH/NHLBI. All are outside the submitted work.Conflict of interest: Dr. Kolb has nothing to disclose. %U https://openres.ersjournals.com/content/erjor/early/2021/05/06/23120541.00257-2021.full.pdf