Expansion of the Surgical Apgar Score across All Surgical Subspecialties as a Means to Predict Postoperative Mortality

Abstract

Background: A surgical scoring system, akin to the obstetrician's Apgar score, has been developed to assess postoperative risk. To date, evaluation of this scoring system has been limited to general and vascular services. The authors attempt to externally validate and expand the Surgical Apgar Score across a wide breadth of surgical subspecialties. Methods: Intraoperative data for 123,864 procedures including all surgical subspecialties were collected and associated with Surgical Apgar Scores (created by the summation of point values associated with the lowest mean arterial pressure, lowest heart rate, and estimated blood loss). Patients' death records were matched to the corresponding score, and logistic regression models were created in which mortality within 7, 30, and 90 days was regressed on the Apgar score. Results: Lower Surgical Apgar Scores were associated with an increased risk of death. The magnitude of this association varied by subspecialty. Some subspecialties exhibited higher odds ratios, suggesting that the score is not as useful for them. For most of the subspecialties the association between the Apgar score and mortality decreased as the time since surgery increased, suggesting that predictive ability ceases to be helpful over time. After

Association between the Surgical Apgar Score and Perioperative Complications after Radical Prostatectomy

“…Patients who are scheduled for radical prostatectomy are generally in a better health condition compared to patients who undergo radical cystectomy or renal mass excision. Our finding might be supported by an analysis [14] of 123,864 surgical procedures that showed that patients who underwent a urologic procedure had a weaker association of SAS and the probability to die within 7 days after surgery. The mortality rate of the latter study and our study (0.5 and 0.1% at 30 days, respectively) are comparable.…”

“…In vascular or trauma surgery, intraoperative tachycardia and hypotension are encountered more frequently and are associated with a poorer outcome. This may explain the better fit of the SAS as a predictor for mortality and high-grade PAE in these patient collectives [6,14] . Our patients were screened preoperatively through electrocardiogram, exercise electrocardiogram and the pulmonary function test to identify obvious cardio-pulmonal morbidity, which is considered a contraindication for radical prostatectomy, and the exclusion of patients with serious cardiac comorbidity might result in presumably more stable hemodynamic conditions indicated by higher SAS scores intraoperatively.…”

Implementing the Surgical Apgar Score in patients with trauma hip fracture

“…3 Renal comorbidity included history of acute or chronic renal disease. 4 Coagulation comorbidity comprised hereditary and acquired coagulation disorder, as well as the use of anticoagulation agents such as warfarin, acetylsalicylic acid and clopidogrel. …”

“…Likewise they are the second capital cause of the hospitalization increasing the postoperative complications and mortality rate of these patients for a shortterm (30-days) and mid-term (6-months) period as well (2,3). According to the studies the novel 10-point Surgical Apgar Score (SAS) has been considered as a good independent predictor of the major postoperative complications and mortality within a period of 30-days after surgery among many surgical subspecialities (4). It is an easy calculated, simple, objective, real-time parameter computed as a sum of the three vital intraoperative variables.…”

Can the Surgical Apgar Score predict morbidity and mortality in general orthopaedic surgery?

“…This 10-point score, which allows risk stratification in the postoperative setting, is based on three variables: the estimated blood loss (EBL), lowest heart rate (HR) and lowest mean arterial pressure (MAP) during surgery (Table 1). This score has been demonstrated to be a good predictor of the occurrence of major complications or death within 30 days of surgery; a high score is associated with a low risk of postoperative major complications or death, while a low score is associated with an increased risk [2,8,10].…”