Utility of Surgical APGAR Score in Risk Stratification for Emergency Gastrointestinal Procedures: A Prospective Analysis
Keywords:
Surgical, APGAR Score, Stratification for Emergency, Gastrointestinal ProceduresAbstract
Background: Emergency gastrointestinal surgery is associated with significant morbidity and mortality. The Surgical APGAR Score (SAS), a simple 10-point scoring system based on intraoperative parameters, has shown promise in predicting postoperative complications. This study aimed to evaluate the utility of SAS in predicting outcomes following emergency gastrointestinal procedures.
Methods: A prospective cross-sectional study was conducted on 30 patients undergoing emergency gastrointestinal surgery under general anesthesia at Mamata Medical College, Khammam, from October 2019 to September 2021. SAS was calculated using lowest heart rate, lowest mean arterial pressure, and estimated blood loss. Patients were followed for 30 days to assess major complications and mortality. Statistical analysis included correlation between SAS scores, complications, and ASA grades.
Results: The mean age was 45.46 ± 16.05 years with slight female predominance (53.3%). Acute intestinal perforation was the most common diagnosis (30%). SAS distribution showed 40% high-risk (0-4), 53.3% medium-risk (5-7), and 6.7% low-risk (8-10) patients. Patients with complications had significantly lower mean SAS scores compared to those without complications (4.65 ± 1.78 vs 6.20 ± 1.22, p=0.001). A strong inverse correlation existed between ASA grade and SAS score (F=44.76, p<0.0001). The 30-day mortality rate was 6.7%. Major complications included prolonged ventilation (13.3%) and wound dehiscence (13.3%).
Conclusions: The Surgical APGAR Score effectively predicts postoperative complications in emergency gastrointestinal surgery. Its simplicity and immediate availability make it a valuable tool for risk stratification and clinical decision-making. Implementation of SAS can enhance patient safety and optimize resource allocation in emergency surgical settings
Downloads
Metrics
References
Vincent C, Moorthy K, Sarker SK, et al. Systems approaches to surgical quality and safety: from concept to measurement. Ann Surg. 2004;239(4):475-482.
Mauey FM, Ebert PA, Sabiston DC, et al. Postoperative myocardial infraction: a study of predisposing factors, diagnosis and mortality in a high risk group of surgical patients. Ann Surg. 1970;172(3):497-503.
Riech DL, Bodian CA, Krol M, et al. Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infraction after coronary artery bypass surgery. Anesth Analg. 1999;83:1075-1076.
Rohrig R, Junger A, Hartman B, et al. The incidence and prediction of automatically detected intraoperative cardiovascular events in noncardiac surgery. Anesth Analg. 2004;98(3):569-577.
Barnett S, Moonesinghe SR. Clinical risk scores to guide perioperative management. Postgrad Med J. 2011;87:535-541.
Knaus WA, Zimmerman JE, Wagner DP, et al. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med. 1981;9(8):591-597.
Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818-829.
Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957-2963.
Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg. 1991;78(3):355-360.
Hartley MN, Sagar PM. The surgeon's 'gut feeling' as a predictor of post-operative outcome. Ann R Coll Surg Engl. 1994;76(6 Suppl):277-278.
Markus PM, Martell J, Leister I, et al. Predicting postoperative morbidity by clinical assessment. Br J Surg. 2005;92(1):101-106.
Goldhill DR. Preventing surgical deaths: critical care and intensive care outreach services in the postoperative period. Br J Anaesth. 2005;95(1):88-94.
Gawande AA, Kwaan MR, Regenbogen SE, et al. An Apgar score for Surgery. J Am Coll Surg. 2007;204(2):201-208.
Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32(4):260-267.
American Society of Anesthesiologists. ASA Physical Status Classification System. Available at: https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system
Gawande AA, Kwaan MR, Regenbogen SE, et al. An Apgar score for surgery. J Am Coll Surg. 2007;204(2):201-208.
Regenbogen SE, Ehrenfeld JM, Lipsitz SR, et al. Utility of the surgical apgar score: validation in 4119 patients. Arch Surg. 2009;144(1):30-36.
Reynolds PQ, Sanders NW, Schildcrout JS, et al. Expansion of the surgical Apgar score across all surgical subspecialties as a means to predict postoperative mortality. Anesthesiology. 2011;114(6):1305-1312.
Thorn CC, Chan M, Sinha N, et al. Utility of the Surgical Apgar Score in a district general hospital. World J Surg. 2012;36(5):1066-1073.
Singh K, Hariharan S. Detecting Major Complications and Death After Emergency Abdominal Surgery Using the Surgical Apgar Score: A Retrospective Analysis in a Caribbean Setting. Turk J Anaesthesiol Reanim. 2019;47(2):128-133.
Haddow JB, Adwan H, Clark SE, et al. Use of the surgical Apgar score to guide postoperative care. Ann R Coll Surg Engl. 2014;96(5):352-358.
Singh K, Hariharan S. Detecting Major Complications and Death After Emergency Abdominal Surgery Using the Surgical Apgar Score: A Retrospective Analysis in a Caribbean Setting. Turk J Anaesthesiol Reanim. 2019;47(2):128-133.
Lin YC, Chen YC, Yang CH, Su NY. Surgical Apgar score is strongly associated with postoperative ICU admission. Sci Rep. 2021;11(1):1-7.
Rajgopal V, Kulkarni SV. Efficacy of the surgical Apgar score in predicting post-operative morbidity and mortality in patients undergoing laparotomy. Int Surg J. 2019;6(8):2791-2796.
Bhushanam KY, Samantaray A, Thottikat K, et al. Validation of surgical APGAR score in abdominal surgeries at a tertiary care teaching hospital in South India. J Clin Sci Res. 2021;10(2):78-85.
Moonesinghe SR, Mythen MG, Grocott MP. High-risk surgery: epidemiology and outcomes. Anesth Analg. 2011;112(4):891-901.
Sobol JB, Gershengorn HB, Wunsch H, Li G. The surgical Apgar score is strongly associated with intensive care unit admission after high-risk intraabdominal surgery. Anesth Analg. 2013;117(2):438-446.
Seagle BL, Alexander AL, Strohl AE, et al. Adherence to quality care measures and improved survival in ovarian cancer. Obstet Gynecol. 2016;128(4):761-769.
Bainbridge D, Martin J, Arango M, Cheng D. Perioperative and anaesthetic-related mortality in developed and developing countries: a systematic review and meta-analysis. Lancet. 2012;380(9847):1075-1081.
Kahan BC, Koulenti D, Arvaniti K, et al. Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries. Intensive Care Med. 2017;43(7):971-979.
Regenbogen SE, Ehrenfeld JM, Lipsitz SR, et al. Utility of the surgical apgar score: validation in 4119 patients. Arch Surg. 2009;144(1):30-36.
Kenig J, Mastalerz K, Lukasiewicz K, et al. The Surgical Apgar Score predicts outcomes of emergency abdominal surgeries both in fit and frail older patients. Arch Gerontol Geriatr. 2018;76:54-59.
Gothwal S, Mohan A, Khan F, Om P. Comparison of Major Complication Rate in High and Low Surgical Apgar Score in Abdominal Surgery Cases. Indian J Surg. 2019;81(2):164-168.
Pearse RM, Moreno RP, Bauer P, et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet. 2012;380(9847):1059-1065.
Weiser TG, Haynes AB, Molina G, et al. Size and distribution of the global volume of surgery in 2012. Bull World Health Organ. 2016;94(3):201-209F.
Lin YC, Chen YC, Yang CH, Su NY. Surgical Apgar score is strongly associated with postoperative ICU admission. Sci Rep. 2021;11(1):1-7.
Vincent JL, Moreno R. Clinical review: scoring systems in the critically ill. Crit Care. 2010;14(2):207.
Prytherch DR, Whiteley MS, Higgins B, et al. POSSUM and Portsmouth POSSUM for predicting mortality. Br J Surg. 1998;85(9):1217-1220.
Thorn CC, Chan M, Sinha N, et al. Utility of the Surgical Apgar Score in a district general hospital. World J Surg. 2012;36(5):1066-1073.
Nepogodiev D, Martin J, Biccard B, et al. Global burden of postoperative death. Lancet. 2019;393(10170):401.
Reynolds PQ, Sanders NW, Schildcrout JS, et al. Expansion of the surgical Apgar score across all surgical subspecialties as a means to predict postoperative mortality. Anesthesiology. 2011;114(6):1305-1312.
Padilla PF, Martínez-Ubieto J, Muñoz-Rodríguez L, et al. Relation between perioperative variables and postoperative morbidity in patients with primary gastrointestinal cancer: multivariate analysis. J Invest Surg. 2020;33(5):426-432.
Ejaz A, Gani F, Frank SM, Pawlik TM. Improvement of the surgical Apgar score by addition of intraoperative blood transfusion among patients undergoing major gastrointestinal surgery. J Gastrointest Surg. 2016;20(10):1752-1759.
Biccard BM, Madiba TE, Kluyts HL, et al. Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. Lancet. 2018;391(10130):1589-1598.
Ihegihu C, Chikwendu C, Ugwu A, et al. Outcome of emergency general surgery in a low-resource setting. World J Surg. 2019;43(6):1426-1432.
Hayashi M, Yoshikawa T, Yura M, et al. Predictive value of the surgical Apgar score on postoperative complications in advanced gastric cancer patients treated with neoadjuvant chemotherapy followed by radical gastrectomy: a single-center retrospective study. BMC Surg. 2020;20(1):308.
Cihoric M, Tengberg LT, Bay-Nielsen M, Foss NB. Prediction of Outcome After Emergency High-Risk Intra-abdominal Surgery Using the Surgical Apgar Score. Anesth Analg. 2016;123(6):1516-1521.
Melis M, Pinna A, Okochi S, et al. Validation of the surgical APGAR score in a veteran population undergoing general surgery. J Am Coll Surg. 2014;218(2):218-225.
Ying Chun L, Yu Chen C, Chih Hsiang Y, Nan Yu S. Surgical Apgar score is strongly associated with postoperative ICU admission. Sci Rep. 2021;11(1):1-7.
Shah NJ, Choudhary RS, Jangir SR, Patel D. Evaluation of surgical Apgar score in predicting post-laparotomy complications. Int Surg J. 2020;7(9):2970-2975..
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
