scholarly journals The risk assessment of surgery for colorectal cancer in elderly patients aged 75 or older using the surgical apgar score

2012 ◽  
Vol 73 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Teiji NAKA ◽  
Masaki SAHARA ◽  
Hiromitsu FUKUNAGA
Keyword(s):  
Colorectal Cancer ◽  
Risk Assessment ◽  
Elderly Patients ◽  
Apgar Score ◽  
Surgical Apgar Score

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

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.

Perioperative Risk Assessment for Gastrectomy by Surgical Apgar Score

2014 ◽  
Vol 21 (8) ◽  
pp. 2601-2607 ◽  
Author(s):  
Yuichiro Miki ◽  
Masanori Tokunaga ◽  
Yutaka Tanizawa ◽  
Etsuro Bando ◽  
Taiichi Kawamura ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Apgar Score ◽  
Perioperative Risk ◽  
Surgical Apgar Score

scholarly journals Correlation of Pre-Operative Co-Morbidity Indices with Peri-Operative and Post-Operative Metrics in Urological Patients Undergoing Major Open Procedures

2019 ◽  
Vol 6 (1) ◽  
pp. 17-21
Author(s):  
Eirini Sarri ◽  
E Fragkiadis ◽  
I Anastasiou ◽  
A Lampadariou ◽  
C Constantinides ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Apgar Score ◽  
Rating Scale ◽  
Morbidity And Mortality ◽  
Operative Risk ◽  
Complication Rates ◽  
Operative Severity Score ◽  
Co Morbidity ◽  
Urological Procedures ◽  
Surgical Apgar Score

Background:Individual surgeon and institutional performance are usually assessed by morbidity and mortality rates, which can be calculated using peri-operative metrics, such as POSSUM (Physiological and Operative Severity Score for the enUmeration of mortality and morbidity). Post-operative risk can be estimated using the surgical Apgar outcome score. However, pre-operative co-morbidity may contribute to case risk diversity and affect immediate peri-operative metrics and short- and long-term morbidity and mortality. We estimated the correlation between pre-operative co-morbidity or risk assessment indices and peri-operative metrics in urological patients. Material and Methods:The study included 100 consecutive patients (80.8% males, mean age ± SD 66.3 ± 10.7 years, range 30 - 88 years) undergoing major open urological procedures (39 nephrectomies, 43 radical prostatectomies, 18 radical cystectomies). Pre-operative co-morbidity was assessed using Charlson Comorbidity Index (CCI), age-adjusted CCI (AA-CCI), Cumulative Illness Rating Scale (CIRS), and Index of Co-Existent Diseases (ICED). Pre-operative risk was assessed with the American Society of Anesthesiologists index (ASA). Functional status was quantified based on estimation of the metabolic equivalent (MET). Peri-operative metrics included POSSUM and surgical Apgar scores. Results: All pre-operative indices significantly correlated with POSSUM, but none correlated with the surgical Apgar score. Conclusions:In patients undergoing major open urological procedures, risk stratification in the post-operative setting using the surgical Apgar score is independent of pre-operative co-morbidity status. In contrast, pre-operative co-morbidity and risk assessment correlated with peri-operative metrics used to calculate morbidity and mortality risk. Reports of death and complication rates do not take into account case diversity and, therefore, should be adjusted for co-morbidity status.

THE FEASIBILITY OF FAST TRACK PROTOCOL FOR ELDERELY PATIENTS WITH COLORECTAL CANCER

2016 ◽  
pp. 26-29
Author(s):  
D. . Zitta ◽  
V. . Subbotin ◽  
Y. . Busirev
Keyword(s):  
Colorectal Cancer ◽  
Colorectal Surgery ◽  
Blood Loss ◽  
Elderly Patients ◽  
Fast Track ◽  
Randomized Study ◽  
Conventional Group ◽  
Intraoperative Blood Loss ◽  
Elective Colorectal Surgery ◽  
Complications Rate

Fast track protocol is widely used in major colorectal surgery. It decreases operative stress, shortens hospital stay and reduces complications rate. However feasibility and safety of this approach is still controversial in patients older than 70 years. The AIM of the study was to estimate the safety and effectiveness of fast track protocol in elderly patients with colorectal cancer. MATERIALS AND METHODS. Prospective randomized study included 138 elective colorectal resectionfor cancer during period from 1.01.10 till 1.06.15. The main criteria for the patients selection were age over 70 years and diagnosis of colorectal cancer. 82 of these patients received perioperative treatment according to fast track protocol, other 56 had conventional perioperative care. Patients underwent following procedures: right hemicolectomy (n=7), left hemicolectomy (n=12), transverse colectomy (n=1), sigmoidectomy (n=23), abdomeno-perineal excision (n=19) and low anterior resection of rectum (n=76). Following data were analized: duration of operation, intraoperative blood loss, time offirst flatus and defecation, complications rates. RESULTS. Mean age was 77,4 ± 8 years. There were no differences in gender, co morbidities, body mass index, types of operations between groups. Duration of operations didn't differ significantly between 2 groups. Intraoperative blood loss was higher in conventional group. The time of first flatus and defecation were better in FT-group. There was no mortality in FT-group vs 1,8 %o mortality in conventional group. Complications rate was lower in FT-group: wound infections 3,6% vs 9 %, anastomotic leakage 4,8 %o vs 9 %o, ileus 1,2 vs 5,4 %o, peritonitis 2,4 %o vs 3,6%o, bowel obstruction caused by the adhesions 6 % vs 5,3 %. Reoperation rate was similar 4,8 % vs 3,6 %. CONCLUSION. Fast track protocol in major elective colorectal surgery can be safely applied in elderly patients. The application of fast track protocol in elderly patients improves the restoration of bowel function and reduces the risk of postoperative complication.

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