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Safwat Eldaabossi,1,2 Yasser Al-Ghoneimy,3 Ayman Ghoneim,3,4 Amgad Awad,5,6 Waheed Mahdi,2– 7 Abdallah Farouk,8,9 Hesham Soliman,10 Hatem Kanany,11 Ahmad Antar,12 Yasser Gaber,13,14 Ahmed Shaarawy,1 Osama Nabawy,1 Moaz Atef,1 Sameh O Nour,1 Ahmed Kabil1 1Department of Chest Diseases, Al-Azhar University, Cairo, Egypt; 2Pulmonology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia; 3Cardiothoracic Surgery Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia; 4Department of Cardiothoracic Surgery, Al-Azhar University, Cairo, Egypt; 5Nephrology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia; 6Department of Internal Medicine, Al-Azhar University, Cairo, Egypt; 7Department of Chest Diseases, Banha Faculty of Medicine, Banha, Egypt; 8Critical Care Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia; 9Department of Critical Care, Alexandria Faculty of Medicine, Alexandria, Egypt; 10Consultant and Chief of Anesthesia, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia; 11Department of Critical Care and Anesthesia, Al-Azhar University, Cairo, Egypt; 12Department of Internal Medicine, Hematology-Oncology Section, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia; 13Radiology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia; 14Department of Radiology, Al-Azhar University, Cairo, EgyptCorrespondence: Ahmed Kabil, Department of Chest Diseases, Al-Azhar University, Cairo, Egypt, Tel +201006396601, Email a_ka_81@hotmail.comBackground: Pulmonary complications after thoracic surgery are common and are associated with prolonged hospital stay, higher costs, and increased mortality. This study aimed to evaluate the value of The Assess Respiratory risk in Surgical Patients in Catalonia (ARISCAT) risk index in predicting pulmonary complications after thoracic surgery.Methods: This retrospective study was conducted at Almoosa Specialist Hospital, Saudi Arabia, from August 2016 to August 2019 and included 108 patients who underwent thoracic surgery during the study period. Demographic data, ARISCAT risk index score, length of hospital stay, time of chest tube removal, postoperative complications, and time of discharge were recorded.Results: The study involved 108 patients who met the inclusion criteria. Their mean age was 42.5 ± 18.9 years, and most of them were men (67.6%). Comorbid diseases were present in 53.7%, including mainly type 2 diabetes mellitus and hypertension. FEV1% was measured in 58 patients, with a mean of 71.1 ± 7.3%. The mean ARISCAT score was 39.3 ± 12.4 and ranged from 24 to 76, with more than one-third (35.2%) having a high score grade. The most common surgical procedures were thoracotomy in 47.2%, video-assisted thoracoscopic surgery (VATS) in 28.7%, and mediastinoscopy in 17.6%. Postoperative pulmonary complications (PPCs) occurred in 22 patients (20.4%), mainly pneumonia and atelectasis (9.2%). PPCs occurred most frequently during thoracotomy (68.2%), followed by VATS (13.6%), and mediastinoscopy (9.1%). Multinomial logistic regression of significant risk factors showed that lower FEV1% (OR = 0.88 [0.79– 0.98]; p=0.017), longer ICU length of stay (OR = 1.53 [1.04– 2.25]; p=0.033), a higher ARISCAT score (OR = 1.22 [1.02– 1.47]; p=0.040), and a high ARISCAT grade (OR = 2.77 [1.06– 7.21]; p=0.037) were significant predictors of the occurrence of postoperative complications.Conclusion: ARISCAT scoring system, lower FEV1% score, and longer ICU stay were significant predictors of postoperative complications. In addition, thoracotomy was also found to be associated with PPCs.Keywords: thoracic surgery, postoperative complications, pulmonary complications, ARISCAT score, atelectasis, pneumonia