Detecting Major Complications and Death After Emergency Abdominal Surgery Using the Surgical Apgar Score: A Retrospective Analysis in a Caribbean Setting

Özet

Objective: The Surgical Apgar Score (SAS) is a simple 10-point scoring system that has been shown to be predictive of major postoperativecomplications and death after surgery. We evaluated the predictive ability of this score in a cohort of patients undergoing emergency abdominalsurgery in a Caribbean tertiary hospital.Methods: The SAS was calculated retrospectively from the anaesthesia records of all patients undergoing emergency abdominal surgery duringa 12-month period. The postoperative surgical records of these patients were then examined for the presence of major complications and death.The association between the SAS and outcomes was tested using binary logistic regression, and the SAS discriminatory ability was determinedfrom the receiver-operating curve (ROC) analysis.Results: Of the 220 patients studied, 72 (33%) suffered an in-hospital major complication or death. The highest complication rate occurred inthe low-scoring groups, with 68% of those scoring <4 being affected. Low-scoring patients (<4) had four times the risk of major complicationswhen compared to higher-scoring groups (relative risk [RR], 4.21; 95% confidence interval [CI], 2.5-7.3; p<0.001). The odds ratio (OR) formajor complications or death per unit increase in the SAS was 0.58 (95% CI, 0.47-0.72; p<0.001). The c-statistic of the SAS for predicting majorcomplications or death was 0.71 (95% CI, 0.68-0.73; p<0.0001).Conclusion: The SAS is a simple 10-point score that can be used in patients undergoing emergency surgery in a Caribbean setting to helpidentify those that are at a higher risk of postoperative complications. Due to its ease in calculation, it can be added to other commonly usedcriteria to help triage the postoperative patient