Utility of the Surgical Apgar Score

Regenbogen, Scott E.; Ehrenfeld, Jesse M.; Lipsitz, Stuart R.; Greenberg, Caprice C.; Hutter, Matthew M.; Gawande, Atul A.

doi:10.1001/archsurg.2008.504

Cited by 149 publications

(127 citation statements)

References 32 publications

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“…The cases with the SAS≤4 had 14.4 times greater odds than the cases with the SAS≥5 for developing 30-days major complications. Our result is almost consistent with other studies in which these poor-scoring patients were 16 times more likely to develop major complications (5,8). This is very important because the median postoperative hospital stay in our study was 10 days.…”

Section: Discussionsupporting

confidence: 93%

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Implementing the Surgical Apgar Score in patients with trauma hip fracture

Sakan

Pavlović

Milošević

et al. 2015

Injury

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Section: Discussionsupporting

confidence: 93%

“…Although this score has been validated in selected orthopaedic procedures (10,11,12,13,14) we also wanted to observe the utility of the SAS in the trauma hip fracture surgery patients. Hip fracture surgery repairs are operations of different magnitude.…”

Section: Discussionmentioning

confidence: 99%

Implementing the Surgical Apgar Score in patients with trauma hip fracture

Sakan

Pavlović

Milošević

et al. 2015

Injury

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“…It achieved a c-statistic of only 0.61, a modest discrimination. This is substantially less compared with the general/vascular surgery validation cohort (c = 0.73) [17]. It is not surprising discrimination was poorer in this population than in the previous validation cohorts, given the important differences in the patients and operations included in the samples.…”

Section: Discussionmentioning

confidence: 77%

The Surgical Apgar Score in Hip and Knee Arthroplasty

Wuerz

Regenbogen

Ehrenfeld

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background A 10-point Surgical Apgar Score, based on patients' estimated blood loss, lowest heart rate, and lowest mean arterial pressure during surgery, was developed to rate patients' outcomes in general and vascular surgery but has not been tested for patients having orthopaedic surgery. Questions/purposes For patients undergoing hip and knee arthroplasties, we asked (1) whether the score provides accurate risk stratification for major postoperative complications, and (2) whether it captures intraoperative variables contributing to postoperative risk based on the three parameters independent of preoperative risk. Patients and MethodsWe retrospectively reviewed the electronic records for all 3511 patients who underwent a hip or knee arthroplasty from March 2003 to August 2006 and extracted data to calculate a Surgical Apgar Score. We evaluated the relationship between scores and likelihood of major postoperative in-hospital complications and assessed its discrimination and calibration. Results Complication rates increased monotonically as the score decreased. Even after controlling for preoperative risk, each 1-point decrease in the score was associated with a 34.0% increase (95% confidence interval, 0.66-0.84) in the odds of a complication. The overall discriminatory performance of the score was a c-statistic of 0.61. Seventysix percent of all major complications occurred in patients classified as low risk with scores of 7 or greater.

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“…Originally developed in patients undergoing general and vascular surgery, the Surgical Apgar Score (SAS) was later validated in different surgical specialties, including colorectal, urological and gynaecological surgery [3][4][5], as well as in different international scenarios [6][7][8][9]. This 10-point score, which allows risk stratification in the postoperative setting, is based on three variables: the estimated blood loss (EBL), lowest heart rate (HR) and lowest mean arterial pressure (MAP) during surgery (Table 1).…”

Section: Introductionmentioning

confidence: 99%

“…This 10-point score, which allows risk stratification in the postoperative setting, is based on three variables: the estimated blood loss (EBL), lowest heart rate (HR) and lowest mean arterial pressure (MAP) during surgery (Table 1). This score has been demonstrated to be a good predictor of the occurrence of major complications or death within 30 days of surgery; a high score is associated with a low risk of postoperative major complications or death, while a low score is associated with an increased risk [2,8,10].…”

Section: Introductionmentioning

confidence: 99%

Can the Surgical Apgar Score predict morbidity and mortality in general orthopaedic surgery?

Urrutia

Valdés

Zamora

et al. 2012

International Orthopaedics (SICOT)

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Purpose The Surgical Apgar Score (SAS) is a simple tally based on intra-operative heart rate, blood pressure and blood loss; it predicts 30-day major postoperative complications and mortality in different surgical fields, but no validation has been performed in general orthopaedic surgery. Methods A prospective assessment of the SAS in 723 consecutive patients undergoing major and intermediate orthopaedic procedures was performed in an 18-month period. The SAS was calculated immediately after surgery, and the occurrence of major complications or death was registered within a 30-day follow-up. Results Thirty-seven patients had ≥1 complication (5.12 %). The complication rate did not augment as the score decreased (SAS 9-1006.56 %; SAS 7-802.62 %; SAS 5-6 07.21 %; SAS ≤4 010.2 %), the relative risk did not augment as the score decreased and the likelihood ratio did not increase with decreasing SAS values, except in the subgroup of patients undergoing spine surgery. The Cstatistic was 0.59 (95 % confidence interval 0.48-0.69), a weak discriminatory value. Using a threshold of 7 to define high-risk and low-risk patients, the SAS allowed risk stratification only for spine surgery. Conclusions The SAS does not predict 30-day major complications and death in patients undergoing general orthopaedic surgery, but it is useful in the subgroup of patients undergoing spine surgery.

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Utility of the Surgical Apgar Score

Cited by 149 publications

References 32 publications

Implementing the Surgical Apgar Score in patients with trauma hip fracture

Implementing the Surgical Apgar Score in patients with trauma hip fracture

The Surgical Apgar Score in Hip and Knee Arthroplasty

Can the Surgical Apgar Score predict morbidity and mortality in general orthopaedic surgery?

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