Surgical Apgar score is strongly associated with postoperative ICU admission

Abstract

Immediate postoperative intensive care unit (ICU) admission can increase the survival rate in patients undergoing high-risk surgeries. Nevertheless, less than 15% of such patients are immediately admitted to the ICU due to no reliable criteria for admission. The surgical Apgar score (SAS) (0–10) can be used to predict postoperative complications, mortality rates, and ICU admission after high-risk intra-abdominal surgery. Our study was performed to determine the relationship between the SAS and postoperative ICU transfer after all surgeries. All patients undergoing operative anesthesia were retrospectively enrolled. Among 13,139 patients, 68.4% and < 9% of whom had a SASs of 7–10 and 0–4. Patients transferred to the ICU immediately after surgery was 7.8%. Age, sex, American Society of Anesthesiologists (ASA) class, emergency surgery, and the SAS were associated with ICU admission. The odds ratios for ICU admission in patients with SASs of 0–2, 3–4, and 5–6 were 5.2, 2.26, and 1.73, respectively (P < 0.001). In general, a higher ASA classification and a lower SAS were associated with higher rates of postoperative ICU admission after all surgeries. Although the SAS is calculated intraoperatively, it is a powerful tool for clinical decision-making regarding the immediate postoperative ICU transfer.

Intensive care unit observation after pancreatectomy: Treating the patient or the surgeon?

“…Such unmeasured variables may explain the finding that the male gender was independently associated with higher odds of ICU transfer from the ward, although this finding is reported in multiple prior studies without a clear explanation. [15][16][17] Institutional practice patterns may have influenced the decision for ICU transfer from the ward, and some complications such as atrial fibrillation may have been managed on the ward in other institutions. Additionally, despite the present evidence suggesting that pancreatectomy type (proximal vs. distal) is not independently associated with postoperative ICU-related outcomes, an analysis of a larger multi-institutional cohort focusing independently on these two populations may have yielded different results.…”

Expert consensus of perioperative intensive care and management of critically ill cancer patients (2021)

“…SAS has been tested in various surgeries with satisfactory results. Calculation of SAS is simple, and it does not require biochemical workups, acute or chronic disease category, clinical assessment, or depend on the nature of the surgery (elective, urgent, emergency) (13). Therefore, SAS is a simple and useful triage tool for anesthesiologist, surgeons and intensivists.…”

Surgical Apgar Score: Utility in Predicting Postoperative Outcome in Cases of Exploratory Laparotomy

“…A score built from those three parameters has proved to be a strong predictor of postoperative outcomes of the patient and due to its availability, inexpensively collectable data and low reliance on technological capacity and resource of the health care centre it is a simple and powerful tool, for assessing risk of post-operative outcomes [5,6]. Since its introduction capability of surgical apgar score in predicting post operative outcomes after different kinds of surgeries and even in predicting outcomes after ICU admissions has been correlated, most of the studies found surgical apgar score to be a strong predictor of the outcomes [7,2,8,9,10].…”