The Surgical Apgar Score

Abstract

Objectives: To review the current literature evaluating the performance of the Surgical Apgar Score (SAS). Background: The SAS is a simple metric calculated at the end of surgery that provides clinicians with information about a patient’s postoperative risk of morbidity and mortality. The SAS differs from other prognostic models in that it is calculated from intraoperative rather than preoperative parameters. The SAS was originally derived and validated in a general and vascular surgery population. Since its inception, it has been evaluated in many other surgical disciplines, large heterogeneous surgical populations, and various countries. Methods: A database and gray literature search was performed on March 3, 2020. Identified articles were reviewed for applicability and study quality with prespecified inclusion criteria, exclusion criteria, and quality requirements. Thirty-six observational studies are included for review. Data were systematically extracted and tabulated independently and in duplicate by two investigators with differences resolved by consensus. Results: All 36 included studies reported metrics of discrimination. When using the SAS to correctly identify postoperative morbidity, the area under the receiver operating characteristic curve or concordance-statistic ranged from 0.59 in a general orthopedic surgery population to 0.872 in an orthopedic spine surgery population. When using the SAS to identify mortality, the area under the receiver operating characteristic curve or concordance-statistic ranged from 0.63 in a combined surgical population to 0.92 in a general and vascular surgery population. Conclusions: The SAS provides a moderate and consistent degree of discrimination for postoperative morbidity and mortality across multiple surgical disciplines.

Usefulness of the Surgical Apgar Score to Predict the Occurrence of Major Complications in the Early Post-Operative Period of Major Surgeries: Experience of Two Second-Category Hospitals in Cameroon

“…The prediction of surgical risk is then important to provide information allowing the clinician to better guide patient care [4]. Thus, immediate postoperative admission in the intensive care unit for patients at risk has shown its effectiveness in limiting the occurrence and controlling the progression of these complications [5].…”

“…Thus, immediate postoperative admission in the intensive care unit for patients at risk has shown its effectiveness in limiting the occurrence and controlling the progression of these complications [5]. Such an anticipatory approach is still only effective for less than 15% of cases concerned, due to the unavailability of reliable and easily accessible post-operative risk stratification criteria [4] [5]. Most of the available exposure criteria, such as socio-anthropomorphic parameters, the ASA and Altemeier scores, do not consider the impact of intraoperative performance on the patient's progress, and taken individually, their reliability remains limited [5] [6]; others such as the "APACHE" system (Acute physiology and chronic evaluation) or the "POSSUM" (The Physiologic and Operative Severity Score for Enumeration of Morbidity and Mortality), are more exhaustive in interpretation but difficult to access and manage in acute contexts [7] [8].…”

Effect of Maternal Oxygenation with Spinal Anesthesia on Neonatal Outcome in Full Term Elective Cesarean Section

“…Apgar scores are recorded at 1-and 5-minutes post-birth. If the score is below 7, both ACOG and AAP recommend expanded Apgar score recording for monitoring the response to resuscitation (6). So, the effect of maternal oxygenation on neonatal outcomes needs further studies, and this study is to detect if mother hyperoxygenation during spinal anesthesia affects neonatal outcomes in full-term elective c-section babies in relation to resuscitation and observation during the first 15-20 minutes.…”

Ability to predict surgical outcomes by surgical Apgar score: a systematic review

“…While some studies support its value in predicting postoperative outcomes, others focusing on gastric, neurosurgery, and orthopedic patients have been unable to establish a consistent relationship [ 11 – 13 ]. According to Pittman et al, the SAS exhibits a modest postoperative morbidity discrimination level and mortality across a variety of surgical specialties [ 14 ].…”