The Surgical Apgar Score predicts outcomes of emergency abdominal surgeries both in fit and frail older patients

A Simple Screening Tool to Predict Outcomes in Older Adults Undergoing Emergency General Surgery

“…Based on results from the multivariable logistic regression analysis and the area under the receiver operating characteristic curve (AUROC), they conclude that the fTRST score is an effective tool for prediction of postoperative short-term mortality and morbidity. Given that older patients undergoing emergency general surgery have the high risks of postoperative morbidity and mortality, 2 findings of this study have potential implications for emergency surgical quality improvement initiatives. To avoid any optimistic interpretation of the results, however, there are some issues in this article that need further clarification and discussion.…”

“…It must be emphasized that besides preoperative health status and comorbidities, surgical burden of patients is another important determinant of short-term mortality and morbidity after emergency surgery. 2,4 Thus, a risk score only including preoperative variables may not well explain postoperative outcomes. The available evidence indicates that surgery type and time, intraoperative large blood loss, and blood transfusion are significantly associated with increased risks of mortality and morbidity after emergency surgery.…”

Prediction of Adverse Outcomes After Emergency General Surgery in Older Patients

“…Based on results from the multivariable logistic regression analysis and the area under the receiver operating characteristic curve (AUROC), they conclude that the fTRST score is an effective tool for prediction of postoperative short‐term mortality and morbidity. Given that older patients undergoing emergency general surgery have the high risks of postoperative morbidity and mortality, findings of this study have potential implications for emergency surgical quality improvement initiatives. To avoid any optimistic interpretation of the results, however, there are some issues in this article that need further clarification and discussion.…”

“…Second, the fTRST score used in this study only included the five preoperative variables indicating preoperative health status and comorbidities (ie, presence of cognitive decline, living alone or no help from partner/family available, reduced mobility or falls in the past 6 months, hospitalized in the past 3 months, and polypharmacy). It must be emphasized that besides preoperative health status and comorbidities, surgical burden of patients is another important determinant of short‐term mortality and morbidity after emergency surgery . Thus, a risk score only including preoperative variables may not well explain postoperative outcomes.…”

Prediction of short‐term mortality after emergency surgery in octogenarians

“…For example, the Surgical Apgar Score based on the estimated blood loss, lowest heart rate and lowest mean artery blood pressure during surgery describes a combination of surgical complexity and the individual patient’s response to surgical stress, and has been proved as a simple assessment method of patients’ surgical burden. The available evidence shows that the Surgical Apgar Score is a powerful predictor of 30‐day postoperative morbidity and mortality both in fit and frail older patients undergoing emergency abdominal surgery . Furthermore, common postoperative complications, such as adverse cardiovascular events, acute kidney injury and pneumonia, have been significantly associated with short‐term mortality of older patients undergoing elective and emergency surgery .…”