Surgical Apgar Score: Validation in a Regional Cancer Centre in Western India

Purpose: Gawande et al. developed a simple intraoperative score (surgical Apgar score based on estimated blood loss, lowest mean arterial pressure and lowest heart rate) to identify patients at higher risk of postoperative complications. We attempted to validate this score in subset of patients undergoing surgery for gynecological malignancies at a tertiary care center. Methods: A total of 100 consecutive patients being operated at the Department of Gynecologic-Oncology, Gujarat Cancer & Research Institute, Ahmedabad, were included in the study. Their clinical preoperative, intraoperative and postoperative parameters were recorded, and each patient was followed for a period of 30 days from the day of surgery. Results: The median age was 51 years, mean ASA class was 2, and mean BMI was 25.8. Of our cohort, 42% underwent surgery for ovarian malignancy, 31% for benign pathology, 17% endometrial, 6% cervical and 4% vulvar cancer. Average SAS was 7. There was significant association between SAS and postoperative complications. With each unit increase in SAS, there was 37.8% reduction in postoperative complications. This was significant even after adjustment with other covariates like age, BMI. Conclusions: Low SAS significantly associates with morbidity in women undergoing surgery for gynecological malignancies. © 2017, Association of Gynecologic Oncologists of India.