Utility of the surgical Apgar score for predicting the short- and long-term outcomes in non-small-cell lung cancer patients who undergo surgery

Abstract

Objectives The surgical Apgar score (SAS) is a simple score that predicts postoperative complications based on three intraoperative valuables. The present study evaluated the association between the SAS and postoperative outcomes in non-small-cell lung cancer (NSCLC) patients who underwent surgery. Methods A total of 585 patients who underwent lung resection were enrolled in the present study. We calculated the SAS of each patient and investigated its influence on the short- and long-term outcomes. Results Postoperative complications of any grade were detected in 164 cases (28%). The morbidity rate increased with decreasing SAS. When all the patients were divided into 2 groups (SAS <7 vs ≥ 7), postoperative complications were observed more frequently in the SAS <7 than in the SAS ≥7 group (41% vs 25%, P < 0.001). In the multivariate analysis, the SAS was an independent risk factor for postoperative complications (odds ratio: 1.64 [1.03–2.61], P = 0.036). In terms of long-term outcomes, the 5-year disease-free survival 54.1% vs 73.2%, P < 0.001) and overall survival (73.8% vs 83.0%, P = 0.031) were significantly worse in the SAS <7 group than in the SAS ≥7 group. In a multivariate analysis, however, the SAS was not found to be an independent prognostic factor for either disease-free survival (hazard ratio: 1.39 [0.97–2.00], P = 0.075) or overall survival (hazard ratio: 0.90 [0.57–1.42], P = 0.642). Conclusions The SAS reflected preoperative and intraoperative characteristics and was able to stratify the morbidity rate, suggesting it to be a useful predictor of short-term outcomes in NSCLC patients who undergo surgery. Clinical registration number The study protocol was approved by the Ethics Review Board for Clinical Studies at Osaka University (control number 18237).

Association between preoperative frailty and surgical Apgar score in abdominal cancer surgery: a secondary analysis of a prospective observational study

“…As expected, patients with lower SAS had worse postoperative outcomes. Some previous studies have adopted different cut-off values for postoperative risk stratification [ 7 , 14 – 16 ]. Although our study used a cut-off value of 7, a sensitivity analysis using a cut-off value of 6 based on the study by Gawande et al [ 5 ] also confirmed the impact of SAS on postoperative outcomes (Supplemental Table 2 ).…”