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. 2010 Sep;148(3):559-66.
doi: 10.1016/j.surg.2010.01.015. Epub 2010 Mar 12.

The intraoperative Surgical Apgar Score predicts postdischarge complications after colon and rectal resection

Scott E Regenbogen  1 , Liliana Bordeianou, Matthew M Hutter, Atul A Gawande
Affiliations

The intraoperative Surgical Apgar Score predicts postdischarge complications after colon and rectal resection

Scott E Regenbogen et al. Surgery. 2010 Sep.

Abstract

Background: We previously developed an intraoperative 10-point Surgical Apgar Score-based on blood loss, lowest heart rate, and lowest mean arterial pressure-to predict major complications after colorectal resection. However, because complications often arise after uncomplicated hospitalizations, we sought to evaluate whether this intraoperative metric would predict postdischarge complications after colectomy.

Methods: We linked our institution's National Surgical Quality Improvement Program database with an Anesthesia Intraoperative Management System for all colorectal resections over 4 years. Using Chi-square trend tests and logistic regression, we evaluated the Surgical Apgar Score's prediction for major postoperative complications before and after discharge.

Results: Among 795 colectomies, there were 230 (29%) major complications within 30 days; 45 (20%) after uncomplicated discharges. Surgical Apgar Scores predicted both inpatient complications and late postdischarge complications (both P < .0001). Late complications occurred from 0 to 27 (median, 11) days after discharge; the most common were surgical site infections (42%), sepsis (24%), and venous thromboembolism (16%). In pairwise comparisons against average-scoring patients (Surgical Apgar Scores, 7-8), the relative risk of postdischarge complications trended lower, to 0.6 (95% confidence interval [CI], 0.2-1.7) for those with the best scores (9-10); and were significantly higher, at 2.6 (95% CI, 1.4-4.9) for scores 5-6, and 4.5 (95% CI, 1.8-11.0) for scores 0-4.

Conclusion: The intraoperative Surgical Apgar Score remained a useful metric for predicting postcolectomy complications arising after uncomplicated discharges. Even late complications may thus be related to intraoperative condition and events. Surgeons could use this intraoperative metric to target low-scoring patients for intensive postdischarge surveillance and mitigation of postdischarge complications after colectomy.

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References

    1. Hutter MM, Rowell KS, Devaney LA, et al. Identification of surgical complications and deaths: an assessment of the traditional surgical morbidity and mortality conference compared with the american college of surgeons-national surgical quality improvement program. J Am Coll Surg. 2006;203(5):618–24. - PubMed
    1. Vincent C, Moorthy K, Sarker SK, et al. Systems approaches to surgical quality and safety: from concept to measurement. Ann Surg. 2004;239(4):475–82. - PMC - PubMed
    1. Schilling PL, Dimick JB, Birkmeyer JD. Prioritizing quality improvement in general surgery. J Am Coll Surg. 2008;207(5):698–704. - PubMed
    1. Medress Z, Fleshner PR. Can we predict unplanned hospital readmission after colectomy for ulcerative colitis and indeterminate colitis? Am Surg. 2007;73(10):998–1001. - PubMed
    1. Hyman N, Manchester TL, Osler T, et al. Anastomotic leaks after intestinal anastomosis: it's later than you think. Ann Surg. 2007;245(2):254–8. - PMC - PubMed

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