Evaluation of the surgical apgar score in patients undergoing Ivor–Lewis esophagectomy

Abstract

Background The Surgical Apgar Score is a simple outcome score based on intraoperative parameters. The scoring system is recently validated in patients undergoing esophagectomy but without comparable results. This study evaluated the ability of the original and modified Surgical Apgar Scores to predict major complications in a patient population undergoing Ivor–Lewis esophagectomy. Methods We retrospectively examined 234 patients who successfully underwent Ivor–Lewis esophagectomy at Rigshospitalet, Copenhagen from November 23, 2011 till November 23, 2014. Major complications were defined as Clavien–Dindo grade IIIa or higher within 30 days after surgery. Univariate and multivariate analyses were performed to assess factors associated with major complications. Receiver operating characteristics were performed for determination of the predictive value of the Surgical Apgar Score scoring systems. Results There were 64 (27.4%) patients with at least one major complication and 4 (1.7%) deaths. The original and modified versions of the Surgical Apgar Score were not associated with major complications and the scoring systems showed no significant predictive value when receiver operating characteristics were performed. Conclusions The original or modified versions of the Surgical Apgar Score could possibly be useful in some subgroups of esophagectomy patients, but should not be considered to have a general predictive value. J. Surg. Oncol. 2017;115:186–191. © 2017 Wiley Periodicals, Inc.

The Reliability of Surgical Apgar Score in Predicting Immediate and Late Postoperative Morbidity and Mortality: A Narrative Review

“…Twenty out of 25 retrospective studies concluded that SAS correlated with adverse postoperative events. The SAS could not predict unfavorable events in patients who underwent knee arthroplasties (Wuerz et al 13 ), hysterectomy for malignancy (Clark et al 22 ), Ivor Lewis esophagectomies (Strøyer et al 19 ), spine surgery for metastasis (Lau et al 25 ), gastrectomy (Miki et al 21 ), and microvascular head and neck reconstruction (Ettinger et al 35 ). The authors felt that preoperative functional status and age were stronger predictors than SAS.…”

The Surgical Apgar Score and frailty as outcome predictors in short- and long-term evaluation of fit and frail older patients undergoing elective laparoscopic cholecystectomy - a prospective cohort study.

“…However, to the best of our knowledge, this is the first study reporting on the SAS in frail older patients. Similarly, we observed that the SAS was a good predictor of postoperative morbidity and mortality in older patients undergoing an emergency surgery [ 6 , 23 ]. There were also reports showing that the SAS had no correlation with the outcome: in orthopaedic procedures (mainly carried out under spinal anaesthesia) [ 24 ], in the microvascular head and neck reconstruction [ 25 ], but also in hysterectomy [ 26 ], oesophagectomy [ 27 ] and gastrectomy [ 28 ].…”

Transcervical versus transthoracic minimally invasive esophagectomy: a randomized and controlled trial protocol

“…The secondary outcomes of the study include the number of harvested lymph nodes, 5-year overall survival (OS) and 5-year disease-free survival (DFS), quality of life (QOL) score, surgical Apgar score (10), and duration of the operation. QOL is scored at randomization, 1-month after surgery, and then every 3 months up to 36 months using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30 (EORTC QLQ-C30) and EORTC QLQ-OES18.…”