Surgical Apgar score can help pinpoint patients at risk for major complications and/or death after surgery
Research Activities, July 2009, No. 347
Efforts to reduce surgery's overall 3 percent major complication rate have been partially hampered, because most hospital surgical departments have no easily applied tool to routinely measure and monitor surgical results. However, a preliminary study shows promising results for a recently developed tool that may be useful for evaluating interventions to prevent poor surgical outcomes. The Surgical Apgar Score calculates a patient's blood loss (BL), lowest heart rate (HR), and lowest mean arterial pressure (MAP) during an operation to identify patients at risk for major complications and/or death within 30 days after surgery.
The researchers used electronic intraoperative records at a major medical center to calculate Surgical Apgar Scores during a 2-year period from July 1, 2003 through June 30, 2005. They used the 10-point score to rate surgical outcomes in a sample of 4,119 general and vascular surgery patients enrolled in the National Surgical Quality Improvement Program at the medical center. Of 1,441 patients with Surgical Apgar Scores of 9 or 10 (best scores), 5 percent developed major complications within 30 days, including two deaths (0.1 percent). By comparison, among 128 patients with scores of 4 or less, 56.3 percent developed major complications and 25 (19.5 percent) died. Each of the three scores was a significant predictor of complications and death.
The mean lowest heart rates were significantly lower (58 vs. 63) and mean lowest MAPs were significantly higher (65 vs. 61) among patients with no complications compared with those with major complications. Likewise, median BL was significantly lower in operations with no major complications than in those resulting in major complications (25 vs. 200 mL). The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00020). See "Utility of the surgical Apgar score," by Scott E. Regenbogen, M.D., M.P.H., Jesse M. Ehrenfeld, M.D., Stuart R. Lipsitz, Sc.D., and others in the January 2009 Archives of Surgery 144(1), pp. 30-36.