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

Abstract

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.

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.…”

Predictive Value of the Surgical Apgar Score on Postoperative Complications in Advanced Gastric Cancer Patients Treated with Neoadjuvant Chemotherapy Followed by Radical Gastrectomy: A Single Center Retrospective Study

“…SAS is determined by the following intraoperative factors: estimated blood loss (EBL), lowest intraoperative mean arterial pressure (LMAP), and lowest heat rate (LHR). Moreover, the modified SAS (mSAS) using a cut off value of EBL has previously been proposed in assessing the PC risk in several types of surgery as well (12)(13)(14)(15). However, previous studies investigating the SAS or mSAS only examined GC patients received primary surgery with or without adjuvant chemotherapy.…”

Predictive Value of the Surgical Apgar Score on Postoperative Complications in Advanced Gastric Cancer Patients Treated with Neoadjuvant Chemotherapy Followed by Radical Gastrectomy: A Single Center Retrospective Study

“…SAS is determined by the following intraoperative factors: estimated blood loss (EBL), lowest intraoperative mean arterial pressure (LMAP), and lowest heart rate (LHR). Moreover, the modi ed SAS (mSAS) using a cut off value of EBL has previously been proposed in assessing the postoperative complication risk in several types of surgery as well (12)(13)(14)(15). However, previous studies investigating the SAS or mSAS only examined gastric cancer patients received primary surgery with or without adjuvant chemotherapy.…”