A PROSPECTIVE STUDY TO DETERMINE POST OPERATIE MORBIDITY AND MORTALITY USING SURGICAL APGAR SCORE

Introduction: Predicting the post-operative complication earlier will help surgeons take necessary precautions Pre and Peri-operatively. It reduces the direct as well as indirect medical cost. The main risk factors which have effect on morbidity as well as mortality are Age ,Type of surgery, History of Diabetes, Hypertension, Smoking, Renal disease, Cardiovascular disease, COPD, Asthma, steroid intake etc. Atul Gawande et al developed a scoring system as a boon for surgeons termed as surgical Apgar scoring system. Though initially devised for Colorectal surgeries this scoring system can be applied for general surgical procedures and predicts major complications as well as mortality using Lowest Heart Rate intra operatively, Lowest Mean Arterial Pressure intra operatively and Estimated Blood Loss. Existing prediction scoring system that involve lab investigation needs meticulous procedure. Hence this study is being carried out to evaluate the ability of Surgical APGAR score to predict post-operative morbidity and 30 days for General Surgical procedures. Materials and methods: Descriptive longitudinal study carried out at Department of General surgery, Meenakshi Medical College & Research Institute, Kanchipuram, Tamil Nadu, for a period of 12 months With a sample size of 200 Inclusion criteria: Patients aged between 15-75 years undergoing Emergency or Elective General surgical procedures under General, Spinal or Epidural anesthesia. Exclusion criteria: Patient on Beta Blockers and those undergoing procedures under Local Anesthesia were excluded. Results: Among the comorbid conditions COPD, Asthma and Renal failure have statistically significant association with Surgical Apgar score. There is statistically significant association between type of surgery and Surgical Apgar score. There is statistically significant association between Surgical Apgar score and complications. There is statistically significant association between surgical Apgar score and mortality. Among 8 individuals who had high risk score 6 individuals had mortality. Conclusion: The 10-point Surgical Apgar Scoring system is an easy and fairly accurate method of identifying the patients at risk of complications and mortality in the post-operative period. Patients with low surgical Apgar score would require more intensive monitoring in the postoperative period even if they are undergoing a minor procedure.

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

Anesthesiology ◽

10.1097/aln.0b013e318219d734 ◽

2011 ◽

Vol 114 (6) ◽

pp. 1305-1312 ◽

Cited By ~ 47

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.

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Risk Assessment of Pancreatic Surgery by Surgical Apgar Score and Body Mass Index

International Surgery ◽

10.9738/intsurg-d-14-00294.1 ◽

2016 ◽

Vol 101 (5-6) ◽

pp. 263-269 ◽

Cited By ~ 1

Author(s):

Toru Aoyama ◽

Yusuke Katayama ◽

Masaaki Murakawa ◽

Koichiro Yamaoku ◽

Amane Kanazawa ◽

...

Keyword(s):

Risk Factors ◽

Pancreatic Cancer ◽

Body Mass Index ◽

Body Mass ◽

Apgar Score ◽

Pancreatic Surgery ◽

Significant Risk ◽

Cancer Center ◽

Estimated Blood Loss ◽

Surgical Apgar Score

Postoperative morbidity is high after pancreatic surgery. Recently, a simple and easy-to-use surgical complication prediction system, the surgical Apgar score (SAS), calculated using 3 intraoperative parameters (estimated blood loss, lowest mean arterial pressure, and lowest heart rate) has been proposed for general surgery. In this study, we evaluated the predictability of the SAS for severe complications after pancreatic surgery for pancreatic cancer. We investigated 189 patients who underwent pancreatic surgery at Kanagawa Cancer Center between 2005 and 2014. Clinicopathologic data, including the intraoperative parameters, were collected retrospectively. In this study, the patients with postoperative morbidities classified as Clavien-Dindo grade 2 or higher were classified as having severe complications. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for morbidity. Postoperative complications were identified in 73 patients, and the overall morbidity rate was 38.6%. The results of both univariate and multivariate analyses of various factors for overall operative morbidity showed that an SAS of 0 to 4 points and a body mass index ≥25 kg/m2 were significant independent risk factors for overall morbidity (P = 0.046 and P = 0.013). The SAS and body mass index were significant risk factors for surgical complications after pancreatic surgery for pancreatic cancer.

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Preoperative Surgical Risk Predictions Are Not Meaningfully Improved by Including the Surgical Apgar Score

Anesthesiology ◽

10.1097/aln.0000000000000858 ◽

2015 ◽

Vol 123 (5) ◽

pp. 1059-1066 ◽

Cited By ~ 8

Author(s):

Maxim A. Terekhov ◽

Jesse M. Ehrenfeld ◽

Jonathan P. Wanderer

Keyword(s):

Risk Stratification ◽

Apgar Score ◽

Information Criteria ◽

Brier Score ◽

Clinical Parameters ◽

Preoperative Risk ◽

Surgical Risk ◽

Estimated Blood Loss ◽

Surgical Apgar Score ◽

Relative Quality

Abstract Background Estimating surgical risk is critical for perioperative decision making and risk stratification. Current risk-adjustment measures do not integrate dynamic clinical parameters along with baseline patient characteristics, which may allow a more accurate prediction of surgical risk. The goal of this study was to determine whether the preoperative Risk Quantification Index (RQI) and Present-On-Admission Risk (POARisk) models would be improved by including the intraoperative Surgical Apgar Score (SAS). Methods The authors identified adult patients admitted after noncardiac surgery. The RQI and POARisk were calculated using published methodologies, and model performance was compared with and without the SAS. Relative quality was measured using Akaike and Bayesian information criteria. Calibration was compared by the Brier score. Discrimination was compared by the area under the receiver operating curves (AUROCs) using a bootstrapping procedure for bias correction. Results SAS alone was a statistically significant predictor of both 30-day mortality and in-hospital mortality (P < 0.0001). The RQI had excellent discrimination with an AUROC of 0.8433, which increased to 0.8529 with the addition of the SAS. The POARisk had excellent discrimination with an AUROC of 0.8608, which increased to 0.8645 by including the SAS. Similarly, overall performance and relative quality increased. Conclusions While AUROC values increased, the RQI and POARisk preoperative risk models were not meaningfully improved by adding intraoperative risk using the SAS. In addition to the estimated blood loss, lowest heart rate, and lowest mean arterial pressure, other dynamic clinical parameters from the patient’s intraoperative course may need to be combined with procedural risk estimate models to improve risk stratification.

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Evaluation of surgical Apgar score in predicting post-laparotomy complications

International Surgery Journal ◽

10.18203/2349-2902.isj20203778 ◽

2020 ◽

Vol 7 (9) ◽

pp. 2970

Author(s):

Nimish J. Shah ◽

Ram Singh Choudhary ◽

Shish Ram Jangir ◽

Divyang Patel

Keyword(s):

Heart Rate ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Apgar Score ◽

Analytical Study ◽

Intensive Monitoring ◽

Operative Complications ◽

Patients At Risk ◽

Surgical Apgar Score ◽

Post Operative Complications

Background: Surgical Apgar score is a simple, objective and economical ten point post-operative prognostic scoring system based on three readily recorded intra operative variables. Aim is to evaluate the applicability and accuracy of the surgical Apgar score in predicting post-operative complications and objectives are to identify patients at risk of developing post-operative complications based on intra-operative data, to study the incidence of post-operative complications and morbidity and mortality in patients undergoing elective and emergency laparotomy.Methods: This was a prospective analytical study carried out at SSG Hospital from November 2018 to October 2019 and achieved sample size was 160 patients. Surgical Apgar score was calculated at the end of the operation from these three parameters: heart rate, mean arterial pressure and expected blood loss.Results: Out of 160 patients, 77 patients were in group 0-5 and complications occurred in 45 patients (58.4%), 54 patients in group 6-7 in which 18 patients (33.3%) suffered a complication and 29 patients in 8-10 surgical Apgar score, rate of complications was 17.3% in category 8-10 Apgar score.Conclusions: Complications are more in low Apgar score patients compared to high Apgar score and in emergency cases compared to elective surgeries, would require more intensive monitoring in the postoperative period.

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The Impact of the Surgical Apgar Score On Oncological Outcomes in Patients With Colorectal Cancer: A Single-Center Retrospective Cohort Study

10.21203/rs.3.rs-1029148/v1 ◽

2021 ◽

Author(s):

Atsushi Sugimoto ◽

Tatsunari Fukuoka ◽

Hisashi Nagahara ◽

Masatsune Shibutani ◽

Yasuhito Iseki ◽

...

Keyword(s):

Colorectal Cancer ◽

Apgar Score ◽

Tumor Type ◽

Cancer Specific Survival ◽

Receiver Operating Characteristic Curves ◽

Oncological Outcomes ◽

Estimated Blood Loss ◽

Comorbidity Index ◽

The Impact ◽

Surgical Apgar Score

Abstract Background: The surgical Apgar score (SAS) predicts postoperative complications (POCs) following gastrointestinal cancer surgery. Recently, the SAS was reported to be a predictor of not only POCs but also the prognosis. However, the impact of the SAS on oncological outcomes in patients with colorectal cancer (CRC) has not been fully examined. The present study therefore explored the oncological significance of the SAS in patients with CRC.Methods: We retrospectively analyzed 639 patients who underwent radical surgery for CRC. The SAS was calculated based on three intraoperative parameters: estimated blood loss, lowest mean arterial pressure and lowest heart rate. The optimal cut-off value of the SAS was determined by receiver operating characteristic curves. All patients were classified into 2 groups based on the SAS (≤6 and >6). The association of the SAS with the recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) was analyzed.Results: Univariate analyses revealed that a lower SAS (≤6) was significantly associated with a worse RFS, OS and CSS. A multivariate analysis revealed that age ≥75 years old, Charlson comorbidity index ≥1, ASA-Physical Status ≥3, SAS ≤6, histologically undifferentiated tumor type and an advanced pStage were independent factors for the OS, and an SAS ≤6 and advanced pStage were independent factors for the CSS.Conclusions: A lower SAS (≤6) was an independent prognostic factor for not only the OS but also the CSS in patients with CRC, suggesting that the SAS might be a useful biomarker predicting oncological outcomes in patients with CRC.

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Can the surgical Apgar score predict morbidity and mortality in general surgery?

International Surgery Journal ◽

10.18203/2349-2902.isj20191514 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1481

Author(s):

Sajan Sehgal ◽

Nagaraj Ravishankar ◽

Divakar Sullery Raghupathi ◽

Nalini Kotekar

Keyword(s):

Mortality Rate ◽

Surgical Procedures ◽

General Surgery ◽

Apgar Score ◽

Morbidity And Mortality ◽

Age Group ◽

Major Complications ◽

Operative Complications ◽

Over 40 Years ◽

Surgical Apgar Score

Background: The objective of the study was to evaluate the effectiveness of surgical Apgar score (SAS) in predicting morbidity and 30 day mortality in general surgical procedures and also to compare the predictability of the score in elective and emergency surgeries for outcome thereafter.Methods: 120 patients undergoing general surgical procedures in JSS Hospital, Mysuru from November 2016 to April 2018 were included in the study. Necessary data was collected. Surgical Apgar score was calculated for each patient and analysis done.Results: 75% of the patients included in the study were in the age group of over 40 years. Around 23% of the patients belong to age group>60 years. 18.25% of patients in the age group >60 years had a low Apgar score of <4. Whereas surgical Apgar score 9-10 was highest in the age group <40 years. Diabetes, hypertension, smoking were significantly associated with post-operative complications. 74.25% of the surgeries involved in the study were elective in nature. Amongst the 35 patients with an Apgar score of <4, major complications occurred in 33% and a 30-day mortality rate of 23% was observed. Morbidity was higher in emergency surgeries as compared to elective surgical procedures.Conclusions: Surgical Apgar score is a simple and useful method of predicting the morbidity and the 30 day mortality of patients undergoing general surgical procedures. It is more sensitive in predicting the outcome in emergency cases as compared to the elective cases.

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PS01.137: CLINICAL IMPACT OF SURGICAL APGAR SCORE IN PREDICTING POSTOPERATIVE COMPLICATIONS AND LONG-TERM PROGNOSIS AFTER ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.137 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 88-89

Author(s):

Sonoko Ishida ◽

Akio Nakagawa ◽

Tetsu Nakamura ◽

Taro Oshikiri ◽

Hiroshi Hasegawa ◽

...

Keyword(s):

Esophageal Cancer ◽

Postoperative Complications ◽

Apgar Score ◽

Scoring System ◽

Clinical Stage ◽

Risk Calculator ◽

Poor Prognostic Factor ◽

Long Term Prognosis ◽

Surgical Apgar Score

Abstract Background Surgical Apgar Score (SAS) is a risk calculator, and is known to predict postoperative complications after surgery. Because it applies three intraoperative parameters, namely estimated blood loss, lowest mean arterial pressure, and lowest heart rate, actual surgical stress is reflected to its scoring system and many studies have reported its usefulness. And in recent years, close relationship between postoperative complications and long-term prognosis has been reported, but there are almost no studies about the relevance between risk calculator of complications and long-term prognosis. Methods A total of 400 patients who underwent esophagectomy for esophageal cancer between January 2007 and January 2017 at our institution were included in this study. Clinicopathological and intraoperative data to calculate SAS were collected from medical records, and a 10-point scoring system based on the original method was used to assign points. Complications classified as Clavien-Dindo grade III or higher were defined as postoperative complications. The relationship between SAS and postoperative complications and long-term prognosis was investigated. Results Postoperative complications occurred in 145 cases (36%). From ROC analysis, we set the SAS cut-off value to 5 points in this study. There were no significant differences in patient's background between the group of SAS ≤ 5 and > 5. Multivariate logistic regression analysis showed that hypertension (P = 0.049) and SAS ≤ 5 (P < 0.0001) were significant predictive factors for postoperative complications. In the prognostic analysis, log-rank analysis showed that patients with SAS ≤ 5 had a significantly poorer prognosis than those with SAS > 5 (P = 0.043), especially in clinical stage 2 or higher esophageal cancer (P = 0.027). In the multivariate analysis, SAS ≤ 5 was revealed to be a significantly poor prognostic factor in clinical stage 2 or higher esophageal cancer (P = 0.029). Conclusion The Surgical Apgar Score can predict postoperative complications, and is also useful to predict long-term prognosis after esophagectomy for esophageal cancer. Disclosure All authors have declared no conflicts of interest.

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

Otolaryngology ◽

10.1177/0194599818756617 ◽

2018 ◽

Vol 159 (1) ◽

pp. 68-75 ◽

Cited By ~ 2

Author(s):

Kristine E. Day ◽

Andrew C. Prince ◽

Chee Paul Lin ◽

Benjamin J. Greene ◽

William R. Carroll

Keyword(s):

Head And Neck Cancer ◽

Length Of Stay ◽

Head And Neck ◽

Neck Cancer ◽

Apgar Score ◽

Postoperative Morbidity ◽

Operative Time ◽

Tertiary Care ◽

Estimated Blood Loss ◽

Surgical Apgar Score

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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Preoperative risk assessment of pancreatic surgery for pancreatic cancer by the surgical Apgar score.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.419 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 419-419

Author(s):

Toru Aoyama ◽

Yusuke Katayama ◽

Masaaki Murakawa ◽

Masahiro Asari ◽

Koichiro Yamaoku ◽

...

Keyword(s):

Risk Factors ◽

Pancreatic Cancer ◽

Body Mass Index ◽

Body Mass ◽

Apgar Score ◽

Pancreatic Surgery ◽

Significant Risk ◽

Cancer Center ◽

Estimated Blood Loss ◽

Surgical Apgar Score

419 Background: Postoperative morbidity is high after pancreatic surgery. Numerous studies have evaluated factors to predict the patients at risk. Recently, a simple and easy-to-use surgical complication prediction system, the surgical Apgar score (SAS) calculated using three intraoperative parameters (estimated blood loss, lowest mean arterial pressure and lowest heart rate) has been proposed for general surgery. In this study, we evaluated the predictability of the SAS for severe complications after pancreatic surgery for pancreatic cancer. Methods: We investigated 189 patients who underwent pancreatic surgery at Kanagawa Cancer Center between 2005 and 2014. Clinicopathological data, including the intraoperative parameters, were collected retrospectively. In this study, the patients with postoperative morbidities classified as Clavien-Dindo grade II or more were classified as having severe complications. Uni- and multivariate logistic regression analyses were performed to identify the risk factors for morbidity. Results: Postoperative complications were identified in 73 patients, and the overall morbidity rate was 38.6%. The results of both univariate and multivariate analyses of various factors for overall operative morbidity showed that a SAS of 0-4 points and a body mass index > 25 kg/m2 were significant independent risk factors for overall morbidity (P=0.024 and P=0.014, respectively). The rate of abdominal abscess formation was significantly higher in the patients with a SAS of 0-4 points, while the occurrence of a pancreatic fistula was significantly higher in the patients with a body mass index > 25 kg/m2. Conclusions: The SAS was a significant risk factor for surgical complications after pancreatic surgery for pancreatic cancer. Careful attention is required for these patients in order to help prevent complications and treat them as soon as they develop.

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Predictive value of Surgical Apgar Score for long-term outcome in patients with gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.178 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 178-178

Author(s):

Masanori Tokunaga ◽

Tomoyuki Irino ◽

Rie Makuuchi ◽

Yutaka Tanizawa ◽

Etsuro Bando ◽

...

Keyword(s):

Gastric Cancer ◽

Apgar Score ◽

Cancer Center ◽

Curative Gastrectomy ◽

Term Survival ◽

Long Term Outcome ◽

Estimated Blood Loss ◽

The Impact ◽

Surgical Apgar Score

178 Background: Recently, a simple and easy complication prediction system, the surgical Apgar score (SAS) calculated according to three intraoperative parameters (estimated blood loss, lowest mean arterial pressure, and lowest heart rate), has been proposed for general surgery. We previously reported on the predictive power of SAS for severe complications after gastrectomy. However, the impact of SAS on long-term survival is still unclear. The aim of the present study was to clarify the relationship between SAS and survival outcome in patients with gastric cancer undergoing curative gastrectomy. Methods: This study included 302 patients who underwent curative gastrectomy at the Shizuoka Cancer Center in 2010. Clinical data, including intraoperative parameters, were collected retrospectively. When the SAS score was ≤ 6, patients were classified into an L-SAS group (n = 82), otherwise, they were classified into an H-SAS group (n = 220). Clinicopathological characteristics and survival outcomes were compared between the groups. Results: There was no difference in demographic data including sex and age between the groups. Total gastrectomy was more frequently performed in the L-SAS group (43%) than in the H-SAS group (21%; P < 0.001). The L-SAS group included patients with higher pT and pN stage. Five-year overall survival rate was worse in the L-SAS group (65.4%) than in the H-SAS group (82.7%; P < 0.001). Multivariate analysis, which included age, sex, histology, pT, pN, type of surgery and SAS as covariates, identified lower SAS (HR, 1.71, 95% C.I., 1.04-2.80) as well as age (HR, 1.62, 95% C.I., 1.10-2.40) and pN (HR, 2.05, 95% C.I., 1.19-3.52) as independent prognostic factors. Conclusions: The SAS was found to be a predictive factor for survival. Intraoperative bleeding and vital signs may affect survival of patients, and therefore warrant special attention from surgeons and anesthesiologists.

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