Use of the surgical Apgar score to enhance Veterans Affairs Surgical Quality Improvement Program surgical risk assessment in veterans undergoing major intra-abdominal surgery

Masi, Antonio; Amodeo, Salvatore; Hatzaras, Ioannis; Pinna, Antonio; Rosman, Alan S.; Cohen, Steven M.; Saunders, John K.; Berman, Russell S.; Newman, Elliot; Ballantyne, Garth H.; Melis, Marcovalerio

doi:10.1016/j.amjsurg.2016.05.017

Cited by 11 publications

(4 citation statements)

References 19 publications

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“…At the end of the surgery, risk scoring was performed using the surgical APGAR score [ 30 ]. Lower surgical APGAR score is associated with increased postoperative mortality and admission to intensive care [ 30 , 31 ]. If the surgical APGAR was ≤4 or the ASA score > 2, the patient was categorised as a major risk patient, otherwise as minor risk patient.…”

Section: Methodsmentioning

confidence: 99%

Implementing Bundle Care in Major Abdominal Emergency Surgery: Long‐Term Mortality and Comprehensive Complication Index

2022

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Background Major abdominal emergency surgery (MAES) has a high risk of postoperative mortality and a high complication rate. The aim of this study was to evaluate whether the implementation of a perioperative care bundle reduced long-term mortality and the Comprehensive Complication Index (CCI) after MAES. Methods This study was a single-centre retrospective cohort study. Data in the intervention group were collected prospectively and compared with a historical cohort from the same centre. It includes adult patients undergoing MAES. We implemented a care bundle under the name Abdominal Surgery Acute Protocol (ASAP). We initiated fast-track initiatives and standardised optimised care in before, during and after surgery. Data were analysed using survival analysis and multiple regression. Results We included 120 patients in the intervention cohort and 258 in the historical cohort. The one-year mortality rate was 21.7% in the intervention cohort compared to 28.3% in the standard care cohort. Adjusted odds ratio of one-year mortality 0.81 (CI95% 0.41–1.56). The 30-day mortality was lowered from 19.0 to 6.7% (p = 0.003). The CCI in the intervention cohort was 8.7 (IQR 0–34) compared to 21 (IQR 0–36) in the control cohort (p = 0.932) The length of stay increased by two days (p = 0.021). Most cases had 71–80% protocol compliance. Conclusion Implementing bundle care in major abdominal emergency surgery lowered the 30-day postoperative mortality. The difference in mortality was preserved over time although not significant after one year. The changes in the Comprehensive Complication Index were not statistically significant.

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Section: Methodsmentioning

confidence: 99%

Implementing Bundle Care in Major Abdominal Emergency Surgery: Long‐Term Mortality and Comprehensive Complication Index

2022

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“…The initial study focused on a cohort of patients undergoing general and vascular surgery, which found that patients with poor scores (≤4) were 16 times more likely to experience a major complication than patients with the highest scores (9 or 10) 2 . The SAS has since been validated in a number of surgical specialties 2‐7 . Although a recent study examined its use among patients undergoing major head and neck reconstruction with a fibular free flap, 8 the SAS has not been evaluated in a population undergoing more general head and neck cancer surgery.…”

Section: Surgical Apgar Score Points 0 1 2 3mentioning

confidence: 99%

“…2 The SAS has since been validated in a number of surgical specialties. [2][3][4][5][6][7] Although a recent study examined its use among patients undergoing major head and neck reconstruction with a fibular free flap, 8 the SAS has not been evaluated in a population undergoing more general head and neck cancer surgery.…”

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confidence: 99%

Utility of the Modified Surgical Apgar Score in a Head and Neck Cancer Population

Day

Prince

Lin

et al. 2018

Otolaryngol.--head neck surg.

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Objective The Surgical Apgar Score (SAS) is a validated postoperative complication prediction model. The purpose of this study was to investigate the utility of the SAS in a diverse head and neck cancer population and to compare it with a recently developed modified SAS (mSAS) that accounts for intraoperative transfusion. Study Design Case series with chart review. Setting Academic tertiary care medical center. Subjects and Methods This study comprised 713 patients undergoing surgery for head and neck cancer from April 2012 to March 2015. SAS values were calculated according to intraoperative data obtained from anesthesia records. The mSAS was computed by assigning an estimated blood loss score of zero for patients receiving intraoperative transfusions. Primary outcome was 30-day postoperative morbidity. Results Mean SAS and mSAS were 6.3 ± 1.5 and 6.2 ± 1.7, respectively. SAS and mSAS were significantly associated with 30-day postoperative morbidity, length of stay, operative time, American Society of Anesthesiologists status, race, and body mass index ( P < .05); however, no significant association was detected for age, sex, and smoking status. Multivariable analysis identified SAS and mSAS as independent predictors of postoperative morbidity, with the mSAS ( P = .03) being a more robust predictor than the SAS ( P = .15). Strong inverse relationships were demonstrated for the SAS and mSAS with length of stay and operative time ( P < .0001). Conclusion The SAS serves as a useful metric for risk stratification of patients with head and neck cancer. With the inclusion of intraoperative transfusion, the mSAS demonstrates superior utility in predicting those at risk for postoperative complications.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Background: The Japanese Gastric Cancer Treatment Guidelines recommend S-1 and S-1 plus docetaxel as postoperative chemotherapy for pathological stage II and III gastric cancer (GC). There is currently no strategy for using chemotherapy to treat high-risk recurrent pathological stage II/III. Previous studies reported that the several nutritional, immunological, and inflammatory markers examined the association with clinical outcomes after surgery for GC. Methods: Ninety patients with GC (stage II, n = 48; stage III, n = 42) for whom gastrectomy was performed at our institution between November 2009 and September 2018 were examined. Nutritional, immunological, and inflammatory markers were calculated from blood samples within 1 week before surgery. Results: The prognostic nutritional index (PNI) status correlated with the pathological stage and disease recurrence after surgery (p = 0.015 and p < 0.0001, respectively). Thirty-three patients had disease recurrence after gastrectomy (stage II, n = 11; stage III, n = 22). The PNI was significantly lower in the recurrent group than in the non-recurrent group (p = 0.0003). The PNI correlated with overall survival and recurrence-free survival after gastrectomy (p = 0.0021 and p = 0.0001, respectively). A multivariate analysis identified the PNI as an independent prognostic factor (p = 0.006). Conclusion: The PNI may be useful for predicting the outcomes of patients with pathological stage II/III GC and may contribute to the selection of an appropriate adjuvant chemotherapy regimen.

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Use of the surgical Apgar score to enhance Veterans Affairs Surgical Quality Improvement Program surgical risk assessment in veterans undergoing major intra-abdominal surgery

Cited by 11 publications

References 19 publications

Implementing Bundle Care in Major Abdominal Emergency Surgery: Long‐Term Mortality and Comprehensive Complication Index

Implementing Bundle Care in Major Abdominal Emergency Surgery: Long‐Term Mortality and Comprehensive Complication Index

Utility of the Modified Surgical Apgar Score in a Head and Neck Cancer Population

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

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