DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20161665

Surgical Apgar score in prediction of post-operative complications in gynecological surgery

Zara Ali, Anjali Mundkur

Abstract


Background: This study was aimed at estimating the ability of 10-point “Surgical Apgar Score” (SAS) to predict postoperative complications in gynecological surgery.

Methods: All women undergoing laparotomy (elective and emergency) in the Department of Obstetrics and Gynecology at Kasturba Hospital, Manipal, between November 2014 and June 2015, were included. Age, BMI, comorbidities and postoperative complications were analyzed. The SAS was calculated from the estimated blood loss, lowest heart rate, and lowest mean arterial pressure. Descriptive statistics and univariate statistics were used. Occurrence of major postoperative complications represented the primary outcome.

Results: A total of 146 cases meeting the inclusion criteria were analyzed. The patients belonged to the age group of 20-60 years. One or more comorbidities were seen to be present in 50 (34.2%) of the patients. With regard to BMI, 62 (42.5%) of the patients were in the normal category. Major post-operative complications were identified in 11 cases (7.5%). On univariate analyses, occurrence of postoperative complications were associated with presence of comorbidities (p=0.047) and SAS belonging to the high-risk category (p=0.001).

Conclusions: The SAS is a significant predictor of postoperative complications following gynecological surgery. This metric, along with a consideration of comorbidities, can be helpful in determining prognosis, directing decision making in the operation theatre, and in postoperative care.

 


Keywords


SAS, Gynecological surgery, Comorbidities

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References


Gawande AA, Kwaan MR, Regenbogen SE. An Apgar score for surgery. J Am Coll Surg. 2007;204:201-8.

Regenbogen SE, Ehrenfeld JM. Utility of the surgical apgar score: validation in 4119 patients. Arch Surg. 2009;144:30-6.

Ferraris VA, Bolanos M. 2014 Identification of patients with postoperative complications who are at risk for failure to rescue. JAMA Surg. 2014;149(11):1103-8.

Erekson EA, Yip SO. Postoperative complications after gynecologic surgery. Obstet Gynecol 2011;118(4):785-93.

Parker D, Burke J, Gallup D. Gynecological surgery in octogenarians and nonagenarians. Obstet Gynecol. 2004;190(5):1401.

Iyer R, Gentry-Maharaj A. Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC—UK gynaecological oncology surgical outcomes and complications). Br J Cancer. 2015;112(3):475-84.

Zighelboim I, Kizer N, Taylor NP. Surgical Apgar Score” predicts postoperative complications after cytoreduction for advanced ovarian cancer. Gynecol Oncol. 2010;116:370-3.

Erekson EA, Yip SO. Major postoperative complications after benign gynecologic surgery: a clinical prediction model. Reconstr Surg. 2012;18(5):274-80.

Regenbogen SE, Bordeianou L. The intraoperative Surgical Apgar Score predicts post-discharge complications after colon and rectal resection. Surgery. 2010;148(3):559-66.

Sharma C, Sharma M. Gynecological diseases in rural India: A critical appraisal of indications and route of surgery along with histopathology correlation of 922 women undergoing major gynecological surgery. J Midlife Health. 2014;5(2):55-61.