Validation of the surgical Apgar score in a neurosurgical patient population

2013 ◽  
Vol 118 (2) ◽  
pp. 270-279 ◽  
Author(s):  
John E. Ziewacz ◽  
Matthew C. Davis ◽  
Darryl Lau ◽  
Abdulrahman M. El-Sayed ◽  
Scott E. Regenbogen ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Hospital Stay ◽  
Apgar Score ◽  
Univariate Analysis ◽  
Postoperative Mortality ◽  
Neurosurgical Procedures ◽  
Complication Rates ◽  
Risk Of Death ◽  
Neurosurgical Patient ◽  
Surgical Apgar Score

Object The surgical Apgar score (SAS) reliably predicts postoperative death and complications and has been validated in a large cohort of general and vascular surgery patients. However, there has been limited study of the utility of the score in the neurosurgical population. The authors tested the hypothesis that the SAS would predict postoperative complications and length of stay after neurosurgical procedures. Methods A cohort of 918 intracranial and spine surgery patients treated over a 3-year period were retrospectively evaluated. The 10-point SAS was calculated and postoperative 30-day mortality and complications rates, intensive care unit (ICU) stay, and hospital stay were assessed by 2 independent raters. Univariate analysis and multivariate logistic regression were performed. Results There were 145 patients (15.8%) with at least 1 complication and 24 patients (2.6%) who died within 30 days of surgery. Surgical Apgar scores were significantly associated with the likelihood of postoperative complications (p < 0.001) and death (p = 0.002); scores varied inversely with postoperative complication and mortality risk in a multivariate analysis. Low SASs also predicted prolonged ICU and hospital stay. Patients with scores of 0–2 stayed a mean of 18.9 days (p < 0.001) and patients with scores of 3–4 stayed an average of 14.3 days (p < 0.001) compared with 4.1 days in patients with scores of 9–10. Conclusions The application of the surgical Apgar score to a neurosurgical cohort predicted 30-day postoperative mortality and complication rates as well as extended ICU and hospital stay. This readily calculated score may help neurosurgical teams efficiently direct postoperative care to those at highest risk of death and complications.

scholarly journals Expansion of the Surgical Apgar Score across All Surgical Subspecialties as a Means to Predict Postoperative Mortality

2011 ◽  
Vol 114 (6) ◽  
pp. 1305-1312 ◽  
Author(s):  
Paul Q. Reynolds ◽  
Neal W. Sanders ◽  
Jonathan S. Schildcrout ◽  
Nathaniel D. Mercaldo ◽  
Paul J. St. Jacques
Keyword(s):  
Apgar Score ◽  
Scoring System ◽  
Postoperative Mortality ◽  
Predictive Ability ◽  
Apgar Scores ◽  
Logistic Regression Models ◽  
Risk Of Death ◽  
Estimated Blood Loss ◽  
Increased Risk ◽  
Surgical Apgar Score

Background A surgical scoring system, akin to the obstetrician's Apgar score, has been developed to assess postoperative risk. To date, evaluation of this scoring system has been limited to general and vascular services. The authors attempt to externally validate and expand the Surgical Apgar Score across a wide breadth of surgical subspecialties. Methods Intraoperative data for 123,864 procedures including all surgical subspecialties were collected and associated with Surgical Apgar Scores (created by the summation of point values associated with the lowest mean arterial pressure, lowest heart rate, and estimated blood loss). Patients' death records were matched to the corresponding score, and logistic regression models were created in which mortality within 7, 30, and 90 days was regressed on the Apgar score. Results Lower Surgical Apgar Scores were associated with an increased risk of death. The magnitude of this association varied by subspecialty. Some subspecialties exhibited higher odds ratios, suggesting that the score is not as useful for them. For most of the subspecialties the association between the Apgar score and mortality decreased as the time since surgery increased, suggesting that predictive ability ceases to be helpful over time. After adjusting for the patient's American Society of Anesthesiologists classification, Apgar scores remained associated with death among most of the subspecialties. Conclusion A previously published methodology for calculating risk among general and vascular surgical patients can be applied across many surgical services to provide an objective means of predicting and communicating patient outcomes in surgery as well as planning potential interventions.

The Surgical Apgar Score Predicts Postoperative Complications in Elderly Patients After Surgery for Colorectal Cancer

2021 ◽  
pp. 000313482110385
Author(s):  
Atsushi Sugimoto ◽  
Tatsunari Fukuoka ◽  
Hisashi Nagahara ◽  
Masatsune Shiutani ◽  
Yasuhito Iseki ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Apgar Score ◽  
Assessment Tool ◽  
Univariate Analysis ◽  
Operation Time ◽  
Estimated Blood Loss ◽  
Surgical Apgar Score

Objective The surgical Apgar score (SAS) has been validated as a risk assessment tool for postoperative complications. However, the utility of the SAS in elderly patients with colorectal cancer remains unclear. In this study, we evaluated the utility of the SAS for predicting the severe complications in elderly patients with colorectal cancer. Methods We retrospectively analyzed 295 patients underwent radical surgery for colorectal cancer in elderly patients ≥75 years old. The SAS was calculated based on 3 intraoperative parameters: estimated blood loss (EBL), lowest mean arterial pressure, and lowest heart rate. Severe complications were defined as Clavien-Dindo classification grade ≥ IIIa. We divided all patients into 2 groups according to with or without severe complications. The optimal cut-off value of SAS for severe complications has been determined by receiver operator characteristic curve. Predictors for severe complications were analyzed by logistic regression modeling. Results Severe complications were observed in 57 patients (19.3%). Male, rectal cancer, operation time (>240 minutes), EBL (≥120 mL), and a low SAS (≤6) were significantly associated with severe complications in univariate analysis. A multivariate analysis revealed that male, rectal cancer, and a low SAS (≤6) were independent predictors for severe complications. Conclusions A low SAS (≤6) was associated with severe complications after colorectal cancer surgery in elderly patients. The SAS is a valuable predictor for severe complications in elderly patients with colorectal cancer.

scholarly journals LYMPHOCYTE COUNT AND PLATELET VOLUME PREDICTS POSTOPERATIVE COMPLICATIONS IN ESOPHAGECTOMY FOR CANCER: A COHORT STUDY

2019 ◽  
Vol 56 (4) ◽  
pp. 377-385 ◽  
Author(s):  
Francisco TUSTUMI ◽  
Flávio Roberto TAKEDA ◽  
Antonio Adolfo Guerra Soares BRANDÃO ◽  
Rubens Antonio Aissar SALLUM ◽  
Ulysses RIBEIRO JUNIOR ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Count ◽  
Univariate Analysis ◽  
Neoadjuvant Chemoradiotherapy ◽  
Postoperative Mortality ◽  
Platelet Volume ◽  
Curative Intent ◽  
Trimodal Therapy ◽  
Esophagectomy For Cancer ◽  
Cellular Components

ABSTRACT BACKGROUND: Biomarkers from routine complete blood count are known predictive factors of long-term outcomes in cancer patients. The value of these biomarkers in the setting of trimodal therapy for esophageal cancer in predicting early postoperative outcomes is not studied. OBJECTIVE: The present study evaluated the value of cellular blood components changes during neoadjuvant chemoradiotherapy followed by curative intent esophagectomy for cancer in predicting postoperative mortality and morbidity. METHODS: A cohort of 149 consecutive patients that underwent chemoradiotherapy using platinum- and taxane-based regimens followed by esophagectomy was analyzed. Cellular components of blood collected before neoadjuvant therapy (period A) and before surgery (period B) were assessed for postoperative mortality and complications. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of blood count variables. RESULTS: Postoperative morbidity was present in 46% of the patients. On multiple regression analysis platelet volume (B) (OR: 1.53; 95% CI: 1.2-2.33) was an independent predictor of general complications. Severe postoperative surgical complications were present in 17% of the patients. On multiple regression analysis, lymphocyte decrease between B-A periods (OR: 0.992; 95% CI: 0.990-0.997) was related to higher risk for severe complications. Cervical anastomotic leakage was present in 25.6% of the patients. On univariate analysis eosinophil count in A and B periods was related to cervical anastomotic leakage. For this outcome, multivariate joint model could not identify independent risk variables of cellular components of blood. The 30-day mortality rate was 7.4%. On univariate analysis, platelet count in period B was associated to higher risk for mortality. The multivariate joint model could not accurately predict mortality due to the few number of patients in the mortality group. CONCLUSION: This is the first study to assess the relationship between peripheral blood count variables changes during neoadjuvant chemoradiotherapy using a platinum- and taxane-based regimen followed by curative intent esophagectomy for cancer in predicting postoperative complications. The platelet volume prior to surgery is related to postoperative complications and the lymphocyte count change prior to surgery predicts severe postoperative complications in the setting of trimodal therapy for esophageal cancer.

P175 TRANSLATION OF MINIMALLY INVASIVE ESOPHAGECTOMY FROM RANDOMIZED CONTROLLED TRIAL SETTING (TIME) TO NATIONAL PRACTICE (DUCA) IN NETHERLANDS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
R Markar Sheraz ◽  
Ni Melody ◽  
Gisbertz Suzanne ◽  
Straatman Jennifer ◽  
van der Peet Donald ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Time Trial ◽  
Reoperation Rate ◽  
Invasive Esophagectomy

Abstract Aims The TIME trial showed reduced pulmonary complications from minimally invasive esophagectomy (MIE) over an open approach, and led to widespread adoption of MIE in the Netherlands. The aim of this study was to compare clinical outcomes from minimally invasive esophagectomy in the DUCA (national dataset) and the TIME trial (RCT) for transthoracic esophagectomy1. Methods Original patient data from the TIME trial1 was extracted along-with data from the Dutch National Cancer Audit (DUCA) (2011-2017). Initially univariate analysis was used to compare patient and tumor demographics and clinical and pathological outcomes from patients receiving MIE in the TIME trial and in the DUCA-dataset. Secondly multivariate analysis, with adjustment patient and tumor factors, was performed for the effect of MIE vs. Open esophagectomy on clinical outcomes in both datasets. Thirdly the datasets were combined and multivariate analysis, was performed for the effect of patient inclusion in TIME trial or DUCA-dataset. Results 115 patients from TIME (59 MIE vs. 56 open) and 4605 patients from the DUCA-dataset (2652 MIE vs. 1953 open) were included. Univariate analysis showed, in TIME trial, MIE reduced postoperative complications and length of hospital stay. However in the DUCA-dataset, MIE increased postoperative complications, re-intervention rate and length of hospital stay, however pathological benefits included increased proportion of R0 margin and lymph nodes harvested. Multivariate analysis confirmed the TIME data showed MIE reduced postoperative complications (OR=0.38, 95%CI 0.16–0.90). In the DUCA-dataset, MIE was associated with increased postoperative complications (OR=1.37, 95%CI 1.20–1.55), re-intervention (OR=1.84, 95%CI 1.57–2.14), and length of hospital stay (Coeff=1.57, 95%CI 0.06–3.08). Pathological benefits to MIE in the DUCA-dataset included a reduction in proportion of R1 margin, and increased lymph node harvest. Multivariate analysis of the combined dataset, showed inclusion in the TIME trial was associated with a reduction in postoperative complications (OR=0.23, 95%CI 0.15–0.36) and reoperation rate (OR=0.34, 95%CI 0.17–0.66). Conclusions MIE when adopted nationally outside the TIME-trial, was associated with an increase in postoperative complications and reoperation rate, which may reflect surgeons on a national level going through their proficiency-gain curve in the technique and outside of expert MIE centers.

scholarly journals The outcomes of isolated ureteral resection and reconstruction in non-urologic cancer patients who underwent cytoreductive surgery (CRC) and hyperthermic intraperitoneal chemotherapy (HIPEC)

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Şevket Barış Morkavuk ◽  
Murat Güner ◽  
Mesut Tez ◽  
Ali Ekrem Ünal
Keyword(s):  
Postoperative Complications ◽  
Hospital Stay ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Postoperative Mortality ◽  
Surgical Oncology ◽  
Ureter Reconstruction ◽  
Management Of Complications ◽  
Significant Difference ◽  
The Mean

Abstract Background Urinary system resections are performed during the cytoreductive surgery with hypertermic intraperitoneal chemotherapy (CRS-HIPEC). However, isolated ureter resection and reconstruction results are uncertain. The aim of this study was to evaluate the postoperative outcomes of isolated ureteral resection and reconstructions in patients who underwent CRC and HIPEC procedure. Methods A total of 257 patients that underwent CRC and HIPEC between 2015 and 2017 in the Department of Surgical Oncology, Faculty of Medicine, Ankara University, were retrospectively analyzed. Twenty patients that had undergone isolated ureteral resection and reconstruction were included in the study. Predisposing factors were investigated in patients who developed postoperative complications. Results The mean age of the patients was 55.1 years. The mean follow-up time of all the patients was 11.6 months. Postoperative mortality occurred in two patients. The mean PCI score was 13.9. Postoperative urologic complications were observed in eight patients after ureter reconstruction. There was no statistically significant difference between the groups in terms of reconstruction techniques and postoperative complications (P = 302). There was no correlation between age (P = 0.571) and gender (P = 0.161) with complications. CRS-HIPEC was performed mostly due to gynecologic malignancy. However, there was no correlation between the primary cancer diagnosis and the development of complications (P = 0.514). The hospital stay duration was higher in the group with complications (16.3 vs 8.8 days, P = 0.208). Conclusions Ureteral resections and reconstructions can be performed for R0/1 resections in CRS-HIPEC operations. It leads to an increase in hospital stay. But there is no significant difference in the development of complications. In the management of complications, conservative approach was sufficient.

scholarly journals Timing of cholecystectomy after percutaneous cholecystectomy for acute cholecystitis- A systematic review and meta-analysis

2021 ◽  
Author(s):  
BHAVIN VASAVADA ◽  
Hardik Patel
Keyword(s):  
Systematic Review ◽  
Hospital Stay ◽  
Biliary Tract ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Mean Difference ◽  
Complication Rates ◽  
Percutaneous Cholecystostomy ◽  
Timing Of Cholecystectomy

Introduction: There is a controversy about the optimum timing of cholecystectomy after percutaneous cholecystostomy. This systematic review and meta-analysis aimed to evaluate outcomes of early versus late cholecystectomy after percutaneous cholecystectomy. Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I2 statistics. The random-effects model was used. We evaluated cholecystectomy performed at different periods after percutaneous cholecystostomy within 72 hours or later, within or after one week or percutaneous cholecystostomy, within 10 days or after 10 days, less than 2 weeks or more than 2 weeks, less than 4 weeks or more than 4 weeks, less than 8 weeks or more than 8 weeks as per literature. Results: Six studies including 18640 patients were included in the final analysis. There was no difference in overall complications within or after 72 hours cholecystectomy group, but mortality and biliary complications were significantly high in the less than 72 hours group (p=0.05 and 0.0002 respectively). There was no difference in mortality, overall complication, biliary tract complications in less than 1 week versus more than 1 week and less than 10 days versus more than 10 days group. Overall complications were significantly less in the less than 2 weeks group compared to the more than 2 weeks group. There was no difference in mortality and biliary tract complications between less than 2 weeks and more than 2 weeks group. Overall complication rate (risk ratio 0.67, p <0.0001), postoperative mortality (risk ratio 0.46, p=0.003), bile duct injury (risk ratio 0.62, p=0.01) was significantly less in earlier than 4-week group. Hospital stay was not significantly different between less than 4 weeks versus more than 4 weeks group. (Mean difference= -2.74, p=0.12). Ove all complication rates were significantly more in less than 8 weeks group. (Risk ratio 1.07, p=0.01). Hospital stay was significantly less in less than 8 weeks group. (Mean difference 0.87, p=0.01). Conclusion: Early cholecystectomy preferably within 4 weeks after percutaneous cholecystostomy is preferable over late cholecystectomy.

Sarcopenia is Associated with Perioperative Outcomes in Gastric Cancer Patients Undergoing Gastrectomy

2019 ◽  
Vol 75 (4) ◽  
pp. 213-222
Author(s):  
Bo Shi ◽  
Siyu Liu ◽  
Junqiang Chen ◽  
Jinlu Liu ◽  
Yihuan Luo ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Skeletal Muscle ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Univariate Analysis ◽  
Psoas Muscle ◽  
Perioperative Outcomes ◽  
Muscle Area ◽  
Skeletal Muscle Index ◽  
Nutrition Risk

Background: Sarcopenia is a syndrome in which skeletal muscle reduction is the main manifestation of age-related and/or disease-related malnutrition associated with postoperative complications and mortality. Objectives: The aim of the current study was to investigate the association between sarcopenia and postoperative complications as well as the nutrition risk of patients with gastric cancer (GC) who received gastrectomy. In addition, a comparative analysis was performed to evaluate the diagnostic accuracy of total psoas muscle area (TPA) and skeletal muscle area (SMA) in sarcopenia. Methods: Preoperative computed tomography scans were obtained from 279 GC patients who received a gastrectomy from June 2011 to May 2016. TPA and SMA at the level of the third lumbar vertebra (L3) were used as the sarcopenia diagnostic index. Patients were diagnosed with sarcopenia via the total psoas muscle index (TPI) and skeletal muscle index (SMI) methods. TPI and SMI were normalized with the square of the patient’s height (m2) by TPA and SMA. The Clavien-Dindo complications score system was used to classify the complication extent after gastrectomy. Univariate and multivariate logistic regression analyses were carried out to evaluate the risk factors for postoperative complications. Results: A total of 68 and 125 patients were diagnosed with sarcopenia by TPI and SMI, respectively. Eighty-eight (31.5%) patients experienced postoperative complications. Patients with sarcopenia also had a significantly extended postoperative stay (TPI-sarcopenia, 15.0 days vs. non-sarcopenia, 11.0 days, p < 0.001; and SMI-sarcopenia, 14.0 days vs. non-sarcopenia, 11.0 days, p < 0.001) and hospital stay (TPI-sarcopenia, 22.5 days vs. non-sarcopenia, 17.0 days, p < 0.001; and SMI-sarcopenia, 21.0 days vs. non-sarcopenia, 16.5 days, p < 0.001). Multivariate logistic analysis showed that both TPI-sarcopenia (OR 7.561, p < 0.001) and SMI-sarcopenia (OR 10.085, p < 0.001) were associated with the risk of postoperative complications. Furthermore, univariate analysis showed a high correlation between nutrition risk screening 2002 (NRS2002) and sarcopenia (p < 0.001). A total of 54 (79.4%) of the 68 patients who were classified as having sarcopenia by TPI and 94 (75.3%) of the 125 patients who were classified as having sarcopenia by SMI were diagnosed with nutritional risk. Conclusions: Sarcopenia is associated with the total length of hospital stay, postoperative hospital stay, and severe complications in GC patients undergoing gastrectomy. Moreover, SMI may be a more meaningful index than TPI in reducing the rate of misdiagnosis and in predicting adverse perioperative risk. In addition, sarcopenia may cause severe malnutrition and increases perioperative adverse risk. Thus, both sarcopenia and the NRS2002 nutritional score should be assessed during preoperative nutritional screening and evaluation for GC patients.

Single Incision Laparoscopic Cholecystectomy Performed via the “Marionette” Technique Shows Equivalence in Outcome and Cost to Standard Four Port Laparoscopic Cholecystectomy in a Selected Patient Population

2015 ◽  
Vol 81 (10) ◽  
pp. 1015-1020 ◽  
Author(s):  
Maryam N. Saidy ◽  
Sunal S. Patel ◽  
Mark W. Choi ◽  
Mohammed Al-Temimi ◽  
Deron J. Tessier
Keyword(s):  
Multivariate Analysis ◽  
Laparoscopic Cholecystectomy ◽  
Blood Loss ◽  
Hospital Stay ◽  
Operative Time ◽  
Single Incision ◽  
Univariate Analysis ◽  
Operating Time ◽  
Complication Rates ◽  
Single Incision Laparoscopic Cholecystectomy

The aim of our study is to compare single incision laparoscopic cholecystectomy (SILC) performed using the “marionette” technique (m-SILC), to the standard four-port technique [four-port laparoscopic cholecystectomy (4PLC)]. Patient information was extracted from a prospectively maintained database (n = 188). Our primary endpoint was operative costs (determined by operating time and instruments used). Secondary endpoints were length of stay, operative time, blood loss, and postoperative complication rates. Univariate and adjusted multivariate analysis was used to compare the outcomes. There were a total of 188 patients for this study. Gender, body mass index, American Society of Anesthesiologists class, and resident participation were similar. Patients undergoing m-SILC were younger (43.8 vs 49.8 years old), less likely to have cholangiogram (32% vs 54%), and were more likely to undergo cholecystectomy for chronic cholecystitis (73.3% vs 52%). In univariate analysis, cholecystectomy performed by the “marionette method” as compared with the 4PLC was associated with shorter operative time (67 vs 59 minutes respectively) and shorter hospital stay (1.2 vs 2.08 days respectively). In multivariate analysis, SILC was associated with shorter hospital stay and comparable operative time, blood loss, and postoperative complications. Instrumentation cost was less in SILC (by $94). SILC done by an experienced surgeon with the “marionette” technique on a carefully selected population shows a statistically significant cost benefit while maintaining clinically comparable outcomes to the standard 4PLC.

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