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October 18, 2010
9:00:00 AM - 11:00:00 AM
Room Hall B1-Area G
Surgical Apgar Score Can Predict Postoperative Complications. Retrospective Study in Our Hospital
  **   Misuzu Hayashi, M.D., Yuki Hateruma, M.D., Satoko Saikawa, M.D., Masakatsu Oshiro, M.D., Kazuhiro Sugahara, M.D.
Anesthesiology, University of the Ryukyus, Okinawa, Japan
Background: A 10-point Surgical Apgar Score (SAS), calculated from intraoperative estimated blood loss, lowest mean arterial pressure, and lowest heart rate, for predicting postoperative complications is a simple and available scoring system. To comfirm the validity of this score, we examined its ability of predictor of major postoperative complications in general surgery in our hospital.

Methods: All eligible patients undergoing general surgery in our hospital between April 1, 2009 and October 31, 2009 were included. Children under 18 years were excluded. SAS was calculated by using electronic intraoperative records. Incidence of major postoperative complications and/or death within 30 days of surgery was also picked out from electronic case records. Major postoperative complications include life-threatening conditions, for example, acute renal failure, cardiac arrest, coma, ventilator use for 48 hr. We examined the relationship between the major complications or death and the SAS statistically.

Results: A total of 200 cases were analyzed. Mean age was 60 years. Major complications occurred in 44 patients (22%), including 2 death (1%). Mode of SAS was 8 points, and mean was 6.5 points (range 0-9). Our analysis revealed that, with decreasing in the SAS, the incidence of major complications increased.[figure1]No complication was reported in patients with the highest SAS score (9 or 10). 75% of patients with scores of 2 or less developed major complications. All of death patients were in the lowest SAS (0 or 1). The relative risk of major complications and death of 4 or less is 5.29 in compared with SAS of 7 (95%CI; 2.2-12.7, p<0.0001). Receiver operating characteristic (ROC) curve for the SAS showed a C statistic of 0.83 for predicting major complications.[figure2]Conclusion: The SAS is available as a prognostic tool to predict postoperative complications risk and could be a good surveillance tool to improve the quality of medical procedures in our hospital.

From Proceedings of the 2010 Annual Meeting of the American Society Anesthesiologists.
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