Utility of the surgical apgar score: validation in 4119 patients. Arch Surg 2009 Jan;144(1):30-6; discussion 37
Date
01/21/2009Pubmed ID
19153322DOI
10.1001/archsurg.2008.504Scopus ID
2-s2.0-58749097614 (requires institutional sign-in at Scopus site) 119 CitationsAbstract
OBJECTIVES: To confirm the utility of a 10-point Surgical Apgar Score to rate surgical outcomes in a large cohort of patients.
DESIGN: Using electronic intraoperative records, we calculated Surgical Apgar Scores during a period of 2 years (July 1, 2003, through June 30, 2005).
SETTING: Major academic medical center.
PATIENTS: Systematic sample of 4119 general and vascular surgery patients enrolled in the National Surgical Quality Improvement Program surgical outcomes database at a major academic medical center.
MAIN OUTCOME MEASURES: Incidence of major postoperative complications and/or death within 30 days of surgery.
RESULTS: Of 1441 patients with scores of 9 to 10, 72 (5.0%) developed major complications within 30 days, including 2 deaths (0.1%). By comparison, among 128 patients with scores of 4 or less, 72 developed major complications (56.3%; relative risk, 11.3; 95% confidence interval, 8.6-14.8; P < .001), of whom 25 died (19.5%; relative risk, 140.7; 95% confidence interval, 33.7-587.4; P < .001). The 3-variable score achieves C statistics of 0.73 for major complications and 0.81 for deaths.
CONCLUSIONS: The Surgical Apgar Score provides a simple, immediate, objective means of measuring and communicating patient outcomes in surgery, using data routinely available in any setting. The score can be effective in identifying patients at higher- and lower-than-average likelihood of major complications and/or death after surgery and may be useful for evaluating interventions to prevent poor outcomes.
Author List
Regenbogen SE, Ehrenfeld JM, Lipsitz SR, Greenberg CC, Hutter MM, Gawande AAAuthor
Jesse Ehrenfeld MD, MPH Sr Associate Dean, Director, Professor in the Advancing a Healthier Wisconsin Endowment department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
FemaleHumans
Male
Middle Aged
Postoperative Complications
Surgical Procedures, Operative
