Use of the surgical Apgar score to guide postoperative care

Haddow, J. B.; Adwan, Hussamuddin; Clark, S.; Tayeh, Salim; Antonowicz, SS; Jayia, P; Chicken, DW; Wiggins, Tom; Davenport, Ross; Kaptanis, Sarantos; Fakhry, M; Knowles, CH; Elmetwally, Ashraf S; Geddoa, Emad; Nair,; Naeem, I; Adegbola, S; Muirhead, LJ

doi:10.1308/003588414x13946184900840

Cited by 34 publications

(24 citation statements)

References 29 publications

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“…Risk scores such as the Surgical Apgar score describe the surgical complexity and the patient's intraoperative response to surgical stress . Whether the score is useful in guiding post‐operative care and triage to the ICU needs to be clarified . Recently, two large cohort studies reported no survival benefit from ICU treatment after surgery .…”

Section: Discussionmentioning

confidence: 99%

Short‐ and long‐term mortality in major non‐cardiac surgical patients admitted to the intensive care unit

Ekeloef

Thygesen

Gögenur

2019

Acta Anaesthesiol Scand

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Worldwide, more than 310 million surgical procedures are undertaken each year with an in-hospital mortality rate between 1.5% and 1.9% in developed countries. 1-3 High-risk patients represent a smaller proportion of the surgical population but accounts for more than 80% of the post-operative deaths. 2 A large database study reported a post-operative mortality of 0.42% in the standard surgical population and 12.3% in the high-risk population. 2 Post-operative complications seems to be the most important cause for poor surgical outcomes, admission to the intensive care unit (ICU) and shortand long-term post-operative mortality. 4-6 Patients undergoing major non-cardiac surgery make out a considerable proportion of the admissions to the ICU and utilise large amounts of resources. 7 While large population-based studies have characterised the high-risk surgical population in general, 2,3 few studies have specifically identified and characterised the high-risk surgical population admitted to the ICU following surgery. By exploring factors associated with morbidity and mortality on the short and long term for this patient group, it might be possible to identify clinically modifiable factors leading to better outcomes. The aim of this study was to characterize patients admitted to the ICU following non-cardiac surgery and identify risk factors associated with 30-days, 90-days and 1-year mortality after ICU admission. Background: The aim of this register-based cohort study was to characterize patients admitted to the intensive care unit (ICU) following non-cardiac surgery and identify risk factors associated with 30-days, 90-days and 1-year mortality after ICU admission. Methods: Patients aged 18+ years admitted to the intensive care unit within 30-days of non-cardiac surgery at four Capital Region hospitals in Denmark between January 2005 and December 2014 were included. Patients were identified through the Danish National Patient Register. The outcomes were 30-days, 90-days and 1-year mortality after ICU admission. Unadjusted and multivariate logistic regression analyses were performed to identify independent risk factors of mortality. Results:The study included 3311 ICU patients. Gastrointestinal surgery accounted for 71.3%, orthopaedic surgery for 18.4% and urologic surgery for 10.2% of the population. For the total population, the median length of stay in hospital was 18 days (9-36, 25th-75th percentile) and 2 days (1-4, 25th-75th percentile) in the ICU. Thirtydays, 90-days and 1-year mortality were 37.8%, 44.5% and 51.2% respectively.Mortality within the ICU was 22.3% while the post-ICU in-hospital mortality was 19.4%. Higher age, comorbidity, delayed ICU admission, acute surgery, and gastrointestinal and orthopaedic surgery increased 30-days, 90-days and 1-year mortality.Conclusions: Short-and long-term mortality in non-cardiac surgical patients admitted to the ICU is very high, especially among the elderly comorbid patients undergoing acute surgery. Future research should focus on targeting clinically modifiable r...

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Section: Discussionmentioning

confidence: 99%

Short‐ and long‐term mortality in major non‐cardiac surgical patients admitted to the intensive care unit

Ekeloef

Thygesen

Gögenur

2019

Acta Anaesthesiol Scand

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“…Out of the 11 prospective studies, one study that analyzed patients undergoing orthopedic surgeries suggested that SAS could not predict adverse surgical outcomes. Haddow et al 39 analyzed 143 general and vascular surgical patients, and suggested conducting a randomized control trial due to the few cases, which provided inconclusive data. Thorn et al 47 found that general and vascular surgery patients with a lower SAS correlated well with postoperative outcomes.…”

Section: Application Of Sas By Other Researchers In Other Surgeriesmentioning

confidence: 99%

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

Nair¹,

Bharuka²,

Rayani³

2018

Rambam Maimonides Med J

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“…The surgical apgar score (SAS) has a strong correlation with the occurrence of major complications or death within 30-d following general and vascular surgery[1-4]. The scoring system is based on three intraoperative variables: Lowest mean arterial pressure, lowest heart rate and estimated intraoperative blood loss.…”

Section: Introductionmentioning

confidence: 99%

Surgical apgar score predicts early complication in transfemoral amputees: Retrospective study of 170 major amputations

Wied

Foss

Kristensen

et al. 2016

WJO

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AIMTo assess whether the surgical apgar score (SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODSThis was a single-center, retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation (TTA) or transfemoral amputation (TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure (ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performed with sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint, performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate, blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups (SAS 0-4, SAS 5-6, SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk (SAS ≥ 7) and high-risk patients (SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery.RESULTSA logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00 (1.33-3.03), P = 0.001]. This effect was pronounced for TFA [OR = 2.61 (1.52-4.47), P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80 (1.40-5.61), P = 0.004] and for the TFA sub-group [OR = 3.82 (1.5-9.42), P = 0.004]. The AUC from the models were estimated as follows: All patients = [0.648 (0.562-0.733), P = 0.001], for TFA patients = [0.710 (0.606-0.813), P < 0.001] and for TTA patients = [0.472 (0.383-0.672), P = 0.528]. This indicates moderate discriminatory power of the SAS in predicting postoperative complications among TFA patients.CONCLUSIONSAS provides information regarding the potential development of complications following TFA. The SAS is especially useful when patients are divided into high- and low-risk groups.

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Use of the surgical Apgar score to guide postoperative care

Cited by 34 publications

References 29 publications

Short‐ and long‐term mortality in major non‐cardiac surgical patients admitted to the intensive care unit

Short‐ and long‐term mortality in major non‐cardiac surgical patients admitted to the intensive care unit

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

Surgical apgar score predicts early complication in transfemoral amputees: Retrospective study of 170 major amputations

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