Surgical Apgar Score - A Simple Prognostic Tool in Surgery

Introduction: In today's era cost of health care is of growing importance and it is important to recognize patients at increased risk of post-operative morbidity and mortality and to find interventions to reduce the risk. Hence, there is a need of an objective prognostic tool to assess the post-operative outcome of patients, than the subjective gut feeling of surgeons. The surgical Apgar score (SAS) is a simple score that uses intraoperative information on hemodynamics and blood loss of patient to predict post-operative morbidity and mortality. Score on a scale of 0-10 calculated from three parameters collected during the operative procedure, lowest heart rate (HR), lowest mean arterial pressure (MAP), and estimated blood loss. Materials and Methods: It is an 18 months prospective study done in St. Martha's Hospital, Bengaluru. Emergency and elective major cases were included in this study. SAS calculated based on intraoperative parameters lowest MAP, lowest HR, and amount of blood loss. Results: A total of 100 patients studied, age ranged from 18 to 70 years. 61 elective and 39 emergency surgeries, the majority were gastrointestinal surgeries. SAS was significantly associated with post-operative morbidity and mortality within 30 days (P < 0.001). Of 100 patients, 30 had SAS 4 or less. Complications noted in 16 out of 30 patients. By comparison among 5 patients with SAS 9 or 10 none experienced complications. Conclusion: SAS is a simple prognostic tool for assessing post-operative outcome in general surgical patients.