Prediction of care after surgery using surgical Apgar score during surgery by surgeons and anesthesiologists

Background: Medical providers continue to maintain a decreased frequency of major hazards aftersurgery for patients undergoing any surgery. Variable postoperative outcomes can be due to differences inpatients’ preoperative risks. The intraoperative surgical Apgar score may predict postoperative one monthhazards.Objective: To show the influence of applying the surgical Apgar score by surgeons and anesthesiologiststogether on clinical outcome after surgery.Methods: Our prospective, double blind and randomized included 166 patients, of both sexes, aged 35-62years, classed I-IV physical status by the American society of anesthesiologists and scheduled fordifferent elective or emergency general surgical procedures with routine outpatient or inpatient follow upafter surgery at Prince Hashim(Zarqa) and King Hussein(Amman) hospitals, Jordan, during theperiod June 2015-June 2016, after obtaining written informed consent from all participants . Patients weredivided into a group I (n=83) with standard outcome after surgery and a group II (n=83) with outcomeaffected by the surgical Apgar score. In the second group, the surgical Apgar score was calculated bygrouping patients into three classes (0-3,4-7 and 8-10). The ten-point surgical Apgar score is recorded atthe end of any surgery from the average blood loss, least mean arterial pressure and least heart rate duringthe surgery. The score is the sum of the points (0, 1, 2, 3 and 4) from each category. The primary outcomeincluded a one month hazards after surgery. Secondary outcome included immediate admissions to theintensive care unit during one month of the primary surgery.Continuous variables were analyzed using Mann–Whitney U test. Categorical variables were analysedusing chi-squared test. Univariate logistic regression was used to compare outcomes in the two groups.Results: Frequency of hazards was comparable in both groups (GI: 24/83 (28.9%), GII: 27/83(32.5%), although it was more in the second group, P> 0.05). Immediate admissions to the intensive careunit was more but not significant in the second group (22/83(26.5%) than in the first group(16/83(19.3%), (P> 0.05).Conclusions: The surgical apgar score may show a discrepancy in postoperative outcome, especially ifdifferences in clinical outcome are to be implemented, using a quality enhancement method.

Keywords:

hazards after surgery , intensive care unit admission , surgical Apgar score