Anesth Pain Med.  2019 Jul;14(3):356-363. 10.17085/apm.2019.14.3.356.

The relationship between the surgical Apgar score and postoperative complications in patients admitted to an intensive care unit after surgery

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea. inyoung_huh@uuh.ulsan.kr

Abstract

BACKGROUND
Surgical Apgar score (SAS) is a 10-point system that measures estimated blood loss, lowest heart rate and lowest mean blood pressure during surgery, and is known to be associated with postoperative complications. The purpose of this study was to evaluate the relationship between SAS and postoperative major complications in patient admitted to intensive care unit (ICU) after surgery.
METHODS
We retrospectively reviewed 543 patients who were admitted to the ICU for 8 months. SAS, patient's demographics and postoperative outcomes were collected and analyzed based on anesthetic record and several medical records in an electronic chart system built in hospital. The patients were divided into three groups based on their SAS. The postoperative major complications, duration of ICU stay and duration of hospital stay were compared among the three groups.
RESULTS
In the low score group, the rate emergency, trauma and hepatobiliary operation were high. In this group, the duration of ICU and hospital stay, use of mechanical ventilation and inotropic in ICU, and postoperative complication were also increased. SAS also had a weak negative correlation with ICU stay and hospital stay. Postoperative complication and mortality rate doubled when compared to reference group (SAS 7-10) according to univariate logistic regression.
CONCLUSIONS
In patients admitted to ICU after surgery, SAS, which can be measured during surgery, is closely related to postoperative parameters including major complications, mortality, and ICU stay. In other words, it is thought that the postoperative outcomes can be improved through appropriate monitoring and intervention for patients with low SAS score.

Keyword

Intensive care unit; Postoperative complications; Surgical Apgar score

MeSH Terms

Apgar Score*
Blood Pressure
Critical Care*
Demography
Emergencies
Heart Rate
Humans
Intensive Care Units*
Length of Stay
Logistic Models
Medical Records
Mortality
Postoperative Complications*
Respiration, Artificial
Retrospective Studies

Figure

  • Fig. 1 Correlation between surgical Apgar score (SAS) and intensive care unit (ICU) stay (A), and discharge day after surgery (B). In (A), there is a weak negative correlation between the duration of ICU stay and SAS (R = 0.307, P < 0.001). In (B), there is also a weak negative correlation between hospital stay and SAS (R = 0.290, P < 0.001). Regr: regression.

  • Fig. 2 Receiver operating characteristic curve showing the performance of surgical Apgar score to predict postoperative mortality. Area under curve (AUC) (95% confidence interval) is 0.663 (0.621–0.702).


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