What is the cut-off value of Surgical Apgar Score which predicts the complicated postoperative evolution of the surgical oncological patient?

Abstract

Introduction: The surgical Apgar score (SAS), which quantifies blood loss, lowest mean blood pressure and lowest heart rate during surgery may be easily calculated at the end of surgery and varies between 0-10 points. Previous studies reported that a low SAS is associated with a complicated outcome. Objective: The study aims to calculate the cut-off value of SAS which predicts the complicated postoperative evolution. Methods: The prospective observational study enrolled all consecutive oncological patients submitted to surgery in Regional Institute of Oncology Iași between 29.01-19.02.2018. SAS was calculated at the end of surgery. The complicated postoperative evolution was assessed by the presence of early organ dysfunctions, postoperative complications (medical/surgical) and the discharge status (alive/deceased). Early cardio-vascular, renal and metabolic dysfunctions were defined as the need for hemodynamic support, the rise of serum creatinine ≥1,5 preoperative value and serum lactate >2mmol/l. Medical and surgical complications were defined according to recognized criteria. The statistical analysis was performed with Excel+Analyse-it®. Results: The study group included 205 patients: early postoperative dysfunction – 26 patients (12,7%); postoperative complications – 33 patients (16%) and mortality – 15 patients (7,3%). The median value of SAS was 8. SAS≤8 was strongly associated with the occurrence of cardiovascular dysfunction (OR=12,7;IC95%=2,77-58; p<0,0001), of postoperative complications (OR=2,35;IC95%=1,1-5; p<0,05), and of death (OR=4,6;IC95%=1,41-15; p<0,01) and SAS≤7 was associated with the occurrence of renal (OR=3,6;IC95%=1,3-9,8; p<0,05) and metabolic dysfunction (OR=14,5;IC95%=3,7-56,6; p<0,0001). Conclusions: The Surgical Apgar Score is a simple and useful tool to predict the complicated postoperative evolution of the oncological patient and a cut-off value of 7 predicts a complicated outcome.