Faculty Collaboration Database

"Surgical Apgar Score" predicts postoperative complications after cytoreduction for advanced ovarian cancer. Gynecol Oncol 2010 Mar;116(3):370-3

Date

12/18/2009

Pubmed ID

20015540

DOI

10.1016/j.ygyno.2009.11.031

Scopus ID

2-s2.0-75749100537 (requires institutional sign-in at Scopus site)   51 Citations

Abstract

OBJECTIVE: A 10-point "Surgical Apgar Score" (SAS) for predicting postoperative complications after general and vascular operations has recently been developed and validated. We sought to estimate the ability of this metric to predict major postoperative complications in women undergoing ovarian cancer cytoreductive procedures.

METHODS: All eligible patients with stage III and IV epithelial ovarian, fallopian tube and primary peritoneal cancer undergoing surgical cytoreduction at our institution between 1999 and 2005 were included. Medical records were reviewed and demographic data, clinicopathologic characteristics, comorbidities and intra and postoperative complications were analyzed. The surgical score was calculated from intraoperative blood loss, lowest mean arterial pressure and lowest heart rate as previously described. Descriptive statistics, univariable and multivariable analyses were used as appropriate. Occurrence of major postoperative complications represented the primary outcome.

RESULTS: A total of 232 cases were analyzed. Mean age was 62 years. Most patients were Caucasian (92%) and diagnosed with stage III disease (83%). Mean duration of surgical procedure was 171 (70-350) minutes. Median SAS was 6 points (range 1-9). On multivariable analyses, occurrence of major postoperative complications was associated with multiple comorbidities (OR 2.2; 95% CI:1.5-3.1; p<0.0001), stage IV disease (OR 2.5; 95% CI:1.1-5.7; p=0.03), ASA class (OR 2.4; 95% CI:1.2-4.7; p=0.01) and SAS<or=4 (OR 7.4; 95% CI:2.9-18.8; p<0.0001).

CONCLUSIONS: Lower SAS (<or=4) is the most powerful predictor of postoperative complications in patients undergoing cytoreductive surgery for advanced epithelial ovarian cancer. This prognostic tool may prove helpful for triaging such patients to optimal postoperative levels of care and directing counseling, monitoring and management in the postoperative period.

Author List

Zighelboim I, Kizer N, Taylor NP, Case AS, Gao F, Thaker PH, Rader JS, Massad LS, Mutch DG, Powell MA

Author

Janet Sue Rader MD Chair, Professor in the Obstetrics and Gynecology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Female
Gynecologic Surgical Procedures
Humans
Middle Aged
Neoplasm Staging
Ovarian Neoplasms
Postoperative Complications
Predictive Value of Tests
Prognosis
Risk Assessment