A Prospective Study to Determine Post Operatie Morbidity and Mortality Using Surgical Apgar Score

Abstract

Introduction: Predicting the post-operative complication earlier will help surgeons take necessary precautions Pre and Peri-operatively. It reduces the direct as well as indirect medical cost. The main risk factors which have effect on morbidity as well as mortality are Age ,Type of surgery, History of Diabetes, Hypertension, Smoking, Renal disease, Cardiovascular disease, COPD, Asthma, steroid intake etc. Atul Gawande et al developed a scoring system as a boon for surgeons termed as surgical Apgar scoring system. Though initially devised for Colorectal surgeries this scoring system can be applied for general surgical procedures and predicts major complications as well as mortality using Lowest Heart Rate intra operatively, Lowest Mean Arterial Pressure intra operatively and Estimated Blood Loss. Existing prediction scoring system that involve lab investigation needs meticulous procedure. Hence this study is being carried out to evaluate the ability of Surgical APGAR score to predict post-operative morbidity and 30 days for General Surgical procedures. Materials and methods: Descriptive longitudinal study carried out at Department of General surgery, Meenakshi Medical College & Research Institute, Kanchipuram, Tamil Nadu, for a period of 12 months With a sample size of 200 Inclusion criteria: Patients aged between 15-75 years undergoing Emergency or Elective General surgical procedures under General, Spinal or Epidural anesthesia. Exclusion criteria: Patient on Beta Blockers and those undergoing procedures under Local Anesthesia were excluded. Results: Among the comorbid conditions COPD, Asthma and Renal failure have statistically significant association with Surgical Apgar score. There is statistically significant association between type of surgery and Surgical Apgar score. There is statistically significant association between Surgical Apgar score and complications. There is statistically significant association between surgical Apgar score and mortality. Among 8 individuals who had high risk score 6 individuals had mortality. Conclusion: The 10-point Surgical Apgar Scoring system is an easy and fairly accurate method of identifying the patients at risk of complications and mortality in the post-operative period. Patients with low surgical Apgar score would require more intensive monitoring in the postoperative period even if they are undergoing a minor procedure.