Surgical apgar score predicts early complication in transfemoral amputees: Retrospective study of 170 major amputations

Abstract

AIMTo assess whether the surgical apgar score (SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODSThis was a single-center, retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation (TTA) or transfemoral amputation (TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure (ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performed with sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint, performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate, blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups (SAS 0-4, SAS 5-6, SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk (SAS ≥ 7) and high-risk patients (SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery.RESULTSA logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00 (1.33-3.03), P = 0.001]. This effect was pronounced for TFA [OR = 2.61 (1.52-4.47), P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80 (1.40-5.61), P = 0.004] and for the TFA sub-group [OR = 3.82 (1.5-9.42), P = 0.004]. The AUC from the models were estimated as follows: All patients = [0.648 (0.562-0.733), P = 0.001], for TFA patients = [0.710 (0.606-0.813), P < 0.001] and for TTA patients = [0.472 (0.383-0.672), P = 0.528]. This indicates moderate discriminatory power of the SAS in predicting postoperative complications among TFA patients.CONCLUSIONSAS provides information regarding the potential development of complications following TFA. The SAS is especially useful when patients are divided into high- and low-risk groups.

Surgical Apgar score is strongly associated with postoperative ICU admission

“…The SAS is a simple formula that uses intraoperative hemodynamics and blood loss to predict postoperative complications and mortality rates 6 . The SAS was found to be positively correlated with postoperative complications and/or mortality in patients undergoing a wide variety of procedures [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] . Due to its ability to predict postoperative complications and mortality, the SAS might also be useful for the prediction of postoperative ICU admission.…”

“…The surgical Apgar score (SAS), which has been widely discussed over the past 10 years, is a simple formula that uses intraoperative hemodynamics and blood loss to predict the postoperative complications and mortality rate (Table 1 ) 6 . The SAS was positively correlated with postoperative complications and/or mortality 7 in patients undergoing vascular surgery, 8 noncardiac surgery 9 , general surgery 8 , esophagectomy 10 , colorectal resection 11 , emergency abdominal surgery 12 , elective laparoscopic cholecystectomy 13 , hepatectomy for hepatocellular carcinoma 14 , liver transplantation 15 , general oncologic surgery 8 , 16 , 17 , laparotomy gynecological surgery 18 , radical or partial nephrectomy for renal mass excision 19 , radical protectomy 20 , hip or knee arthroplasty 21 , transfemoral amputation 22 , lumbar fusion for degenerative spine diseases 23 , intracranial meningioma 24 , and head and neck cancer 13 , 25 .…”

Clinical Impact of the Prognostic Nutritional Index as a Predictor of Outcomes in Patients with Stage II/III Gastric Cancer: A Retrospective Cohort Study

“…Recent studies reported that the surgical Apgar score (SAS) is useful for predicting the risk of complications after gastrectomy and survival after surgery for GC [2,3]. The usefulness of SAS in some surgical fields has been validated [4][5][6][7][8][9]. On the other hand, the prognostic nutritional index (PNI) is calculated from serum albumin concentrations and total lymphocyte counts in peripheral blood and reflects the nutritional and immunological status.…”

Research on Data Mining Application of Orthopedic Rehabilitation Information for Smart Medical

“…With the further development of medical standards, people have put forward higher requirements for medical and health care, but due to the deterioration of the ecological environment, people's health has seriously damaged. Especially children, because of their lack of self-protection awareness, the incidence of illness is high [4]. Under this circumstance, the growth rate of medical The associate editor coordinating the review of this manuscript and approving it for publication was Yongtao Hao.…”