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

Nair, Abhijit; Bharuka, Aanchal; Rayani, Basanth Kumar

doi:10.5041/rmmj.10316

Cited by 29 publications

(18 citation statements)

References 53 publications

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“…In our case series, only the SAS turned to be an independent risk factor. Our results are consistent with those obtained by other authors and summarized in the review on the SAS by Nair et al published in 2017 [ 5 ]. Twenty out of 25 retrospective and 9 out of 11 prospective studies confirmed that the SAS correlated with postoperative morbidity and mortality.…”

Section: Discussionsupporting

confidence: 94%

“…Twenty out of 25 retrospective and 9 out of 11 prospective studies confirmed that the SAS correlated with postoperative morbidity and mortality. The cut-offs were different between the studies but most of the authors used 6/7 points to differentiate between low- and high-risk patients [ 5 ]. However, to the best of our knowledge, this is the first study reporting on the SAS in frail older patients.…”

Section: Discussionmentioning

confidence: 99%

“…The Surgical Apgar Score (SAS), proposed by Gawande et al , is a simple and rapid scoring system, using only three elements extracted from anaesthesia records (estimated blood loss, lowest intraoperative heart rate and lowest intraoperative mean arterial pressure) [ 4 ]. It was validated in a large cohort of general surgical patients, and also by our team, in older patients undergoing emergency surgery [ 5 , 6 ]. However, it remains unknown whether the SAS might be useful in older fit and frail patients undergoing elective cholecystectomy, which is one of the most common surgical procedures in the older population.…”

Section: Introductionmentioning

confidence: 99%

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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

Mastalerz¹,

Kenig²,

Olszewska³

et al. 2018

wiitm

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IntroductionFrailty increases the risk of poor surgical outcomes in the older population. Some intraoperative factors may also influence the final result and can be evaluated. The Surgical Apgar Score (SAS) is a simple system predicting postoperative mortality and morbidity. However, the utility of the SAS remains unknown in fit and frail older patients undergoing elective laparoscopic cholecystectomy due to benign gallbladder diseases.AimTo evaluate the usefulness of the SAS in predicting 30-day morbidity and 1-year mortality in older fit and frail patients undergoing elective laparoscopic cholecystectomy.Material and methodsConsecutive patients (≥ 70 years) were enrolled in the prospective study. The Comprehensive Geriatric Assessment (CGA) was used to diagnose frailty. Logistic regression was conducted to investigate the association between the scores and the outcomes.ResultsThe study included 144 consecutive older patients with a median age of 76 (range: 70–91) years. The prevalence of frailty was 44.4%. The 30-day mortality and morbidity were 0% and 11.8%, respectively. The 1-year mortality was 6.3% and 7 out of 9 occurred in the frail group. SAS < 7 points was identified as an independent predictor of 30-day postoperative morbidity (OR = 5.1; 95% CI: 1.5–18.1). Age > 85 years (OR = 1.9; 95% CI: 1.2–16.4) and frailty (OR = 3.4; 95% CI: 1.1–19.3) were predictors of 1-year mortality.ConclusionsLaparoscopic cholecystectomy can be safely performed in older fit and frail patients. The SAS, not age, turned out to be the most important predictor of 30-day morbidity. Frailty and age > 85 years were predictors of 1-year mortality. Older patients with SAS < 7 points should be followed meticulously in order to diagnose and treat potential complications early on.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

Mastalerz¹,

Kenig²,

Olszewska³

et al. 2018

wiitm

View full text Add to dashboard Cite

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“…four to sevenfold increase in postoperative complications compared to ASA ≤ 2 [25]. Nair et al [22] also noted that the SAS could predict either alone, or in combination with other risk factors, the occurrence of postoperative complications. Therefore, the combination of the SAS and the patient's preoperative physical status may be an ideal model to predict postoperative complications.…”

Section: Resultsmentioning

confidence: 99%

“…Anesthesiologists should also keep in mind that the careful management of intraoperative blood pressure may lead to improved postoperative patients' outcomes. It has been reported that the SAS was not correlated with the postoperative outcomes in orthopedic surgeries performed under regional anesthesia [6,17,22]. Nair et al [22] noted that the initial hypotension that occurred after the administration of a spinal anesthetic was associated with the poor SAS correlation with postoperative complications.…”

Section: Resultsmentioning

confidence: 99%

The Surgical Apgar Score can help predict postoperative complications in femoral neck fracture patients: a 6-year retrospective cohort study

Kotera

2018

JA Clin Rep

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Introduction: The postoperative mortality rate following a femoral neck fracture remains high. The Surgical Apgar Score (SAS), based on intraoperative blood loss, the lowest mean arterial pressure, and the lowest heart rate, was created to predict 30-day postoperative major complications. Here, we evaluated the relationship between the SAS and postoperative complications in patients who underwent femoral neck surgeries. Methods: We retrospectively collected data from patients with femoral neck surgeries performed in 2012-2017 at Kumamoto Central Hospital. The variables required for the SAS and the factors presumably associated with postoperative complications including the patients' characteristics were collected from the medical charts. Intergroup differences were assessed with the χ 2 test with Yates' correlation for continuity in category variables. The Mann-Whitney U test was used to test for differences in continuous variables. We assessed the power of the SAS value to distinguish patients who died ≤ 90 days post-surgery from those who did not, by calculating the area under the receiver operating characteristic curve (AUC). Results: We retrospectively examined the cases of 506 patients (94 men, 412 women) aged 87 ± 6 (range 70-102) years old. The 90-day mortality rate was 3.4% (n = 17 non-survivors). There were significant differences between the non-survivors and survivors in body mass index (BMI), the presence of moderate to severe valvular heart disease, albumin concentration, the American Society of Anesthesiologists (ASA) classification, and the SAS. The 90-day mortality rate in the SAS ≤ 6 group (n = 97) was 10.3%, which was significantly higher than that in the SAS ≥ 7 group (n = 409), 1.7%. The AUC value to predict the 90-day mortality was 0.70 for ASA ≥ 3 only, 0.71 for SAS ≤ 6 only, 0.81 for SAS ≤ 6 combined with ASA ≥ 3, and 0.85 for SAS ≤ 6 combined with albumin concentration < 3.5 g/ dl, BMI ≤ 20, and the presence of moderate to severe valvular heart disease. Conclusions: Our results suggest that the SAS is useful to evaluate postoperative complications in patients who have undergone a femoral neck surgery. The ability to predict postoperative complications will be improved when the SAS is used in combination with the patient's preoperative physical status.

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Perioperative Monitoring in High-Risk Surgical Patients: A Step-by-Step Approach

Roasio

2023

The High-Risk Surgical Patient

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

Cited by 29 publications

References 53 publications

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

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

The Surgical Apgar Score can help predict postoperative complications in femoral neck fracture patients: a 6-year retrospective cohort study

Perioperative Monitoring in High-Risk Surgical Patients: A Step-by-Step Approach

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