An esophagectomy Surgical Apgar Score (eSAS)-based nomogram for predicting major morbidity in patients with esophageal carcinoma

Abstract

Background: Performing an esophagectomy for a malignancy presents an operation with an elevated risk of complications. The esophagectomy Surgical Apgar Score (eSAS) has been confirmed to be a strong predictor of major postoperative morbidity. The purpose of this study was to construct and establish an eSAS-based nomogram for predicting major morbidity after esophagectomy for esophageal carcinoma.Methods: A total of 194 patients underwent radical esophagectomy for the malignant disease was analyzed by internal validation, and the clinical value was calculated on external validation (n=135). The 30-day major morbidity was recorded as the outcome. Univariable and multivariable logistic regression analysis analyzed the preoperative and intraoperative variables. An eSAS-based nomogram was constructed to predict the risk of major postoperative morbidity. The verification curves for the performance were drawn.Results: Major morbidity occurred in 34.04% (n=66) of cases. Based on the final regression analysis, we proved that the eSAS had a highly linear association with major morbidity after esophagectomy. We further constructed a nomogram integrating the eSAS and clinical predictors [body mass index (BMI), American Society of Anesthesiologists (ASA) classification, and diabetes mellitus] to predict the probability of major postoperative morbidity. The performance of the eSAS-based nomogram was assessed and proven to be clinically useful by internal and external validation. Conclusions:We constructed an eSAS-based nomogram that can effectively predict the risk of major morbidity after esophagectomy in patients with esophageal carcinoma. With a highly exact and exceedingly simple model, clinicians could more precisely ease the individual perioperative management for decreasing the postoperative complication.

Utility of the surgical Apgar score for predicting the short- and long-term outcomes in non-small-cell lung cancer patients who undergo surgery

“…An increased blood loss causes intravascular volume depletion and leads to a lower blood pressure and a higher HR. Furthermore, the intraoperative MAP and HR are greatly affected by anaesthesia management, such as the anaesthetic depth, fluid volume control and use of vasoactive agents, as well as the patient’s physical background [ 17 ]. Indeed, Regenbogen et al [ 4 ] compared the prognostic value of SAS before and after adjusting for a detailed risk-prediction model and concluded that the SAS is a useful indicator of the surgical quality.…”

The cisplatin-induced acute kidney injury is a novel risk factor for postoperative complications in patients with esophageal cancer: a retrospective cohort study

“…The PS was derived from models including age, sex, body mass index, eGFR, hemoglobin, CRP, albumin, urinary protein, Brinkman Index, height-adjusted total kidney volume measured on CT, type of neoadjuvant chemotherapy, pharyngo-laryngoesophagectomy, comorbidities and medications as listed in Table 1 . These clinical variables used to create the propensity score were selected from the factors that have been reported as risk factors for postoperative complications and AKI [ 3 – 5 , 10 , 11 ]. Further adjustments for time-averaged eGFR, albumin levels, body weight ratio, and CRP were performed.…”

“…Transthoracic esophagectomy is highly invasive, and complications, such as anastomotic leakage and postoperative pneumonia, frequently occur [ 2 ]. Risk factors for postoperative complications include older age, malnutrition, anemia, obesity, and underlying diseases such as cardiac disease and diabetes mellitus [ 3 – 5 ]. Postoperative complications prolong hospital stays, impair patients’ activities of daily living [ 6 ], and lead to poorer prognosis [ 7 – 9 ].…”

Esophageal surgical Apgar score (eSAS): A predictor for postoperative morbidity in patients undergoing neoadjuvant therapy and esophagectomy

“…However, the value of the SAS in EC remains obscure and disputable. The aim of the present study was to elucidate the mathematical relationship between the esophageal surgical Apgar score (eSAS) and postoperative morbidity or prognosis 22,23 …”