S. M. Manstein1, N. Goel1, W. H. Ward1, L. Demora1, E. A. Ross1, S. S. Reddy1, M. C. Smaldone1, J. M. Farma1, C. S. Chu1, A. Kutikov1, D. Y. Chen1, M. N. Lango1, R. Viterbo1, J. A. Ridge1, A. Karachristos1, R. G. Uzzo1, N. F. Esnaola1 1Fox Chase Cancer Center,Surgical Oncology,Philadelphia, PA, USA
Introduction:
Major cancer surgery is associated with significant risks of perioperative morbidity and mortality, resulting in delayed adjuvant therapy, higher recurrence rates, and worse overall survival. Previous retrospective studies have promoted use of the Surgical Apgar Score (SAS) for preoperative risk assessment. This study prospectively evaluated the predictive value of SAS to predict serious complication (SC, as defined by the American College of Surgeons National Surgical Quality Improvement Program) in cancer patients undergoing elective major surgery.
Methods:
Demographic, comorbidity, procedure, and intraoperative data was collected prospectively for 405 cancer patients undergoing elective major surgery at a single NCI-designated comprehensive cancer center between 2014-17. The SAS was calculated immediately postoperative and outcome data was collected prospectively. Rates of SC according to SAS risk category were compared using Cochran-Armitage trend test. As a measure of discrimination, receiver operator characteristic (ROC) curves were generated and area under the ROC curves (AUC) and 95% confidence intervals (CI) were calculated.
Results:
The median age was 64 years of age (range, 23-86); 44.0% of patients were female, 12.8% were non-Caucasian, 2.5 % were Latino. 77.8% of patients were ASA status classification 1-2, while 22.2% were ASA status classification 3 or greater. The distribution of patients who underwent head and neck, upper gastrointestinal/hepatico-pancreatico-biliary, colorectal, gynecologic, urologic, or reconstructive is shown in Table 1. 80.0%, 17.3%, and 2.7% of patients were deemed to be at low (SAS 7-10), intermediate (SAS 5-6), or high risk (SAS 0-4) for SC based on their immediate postoperative SAS. Forty-six patients (11.4%) ultimately experienced a SC within 30 days; 3.7% returned to the operating room, 3.7% experienced a urinary tract infection, 3.2% experienced a respiratory complication, 2.7% experienced a wound complication, and 1.2% experienced a cardiac complication. Overall, 9.3%, 18.6%, and 27.3% of patients with SAS 7-10, 5-6, or 0-4 experienced a SC, respectively (P=.005). The overall discriminatory ability of the SAS, however, was modest (AUC 0.661; 95%CI, 0.582-0.740).
Conclusion:
The majority of patients who underwent elective major cancer surgery in our cohort were deemed to be at low risk for adverse events based on their immediate postoperative SAS. Although there was an overall association between SAS and higher risk of subsequent postoperative SC in our cohort, the ability of the SAS to accurately predict risk of postoperative SC at the patient-level was limited.
