A. Masi1, M. Choudhary1, K. Chao1, K. Barrera1, L. Dresner1, M. Muthukumar1, R. Gruessner1, V. Roudnitsky1 1Kings County Hospital Center,Surgery/Trauma,Brooklyn, NY, USA
Introduction:
The Surgical Apgar Score (SAS) has been shown to correlate with postoperative morbidity and mortality in patients undergoing elective general surgery, but has never been validated in a Trauma patient population.
Methods:
We retrospectively collected data on demographics, medical history, type of surgery, and post-operative outcomes for any patient undergoing emergent laparotomy due to trauma during the period Jan 2014-Aug 2016 at our Level 1 trauma center. We categorized patients in 3 groups according to their SAS, a 10-point scoring system calculated using limited intra-operative data (blood losses, lowest mean arterial pressure, lowest heart rate). Differences between SAS groups were evaluated with Pearson’s χ2 and ANOVA as appropriate. The study primary end-points were overall morbidity ( post-operative complication according to Clavien’s classification) and 30-day mortality, the secondary end-points were ICU Length of Stay (LOS) and Hospital LOS.
Results:
During the study period 177 patients underwent emergent laparotomies due to trauma. After exclusion of patients with intra-operative mortality and/or missing variables, 160 were available for analysis (SAS 0-3: n=27; SAS 4-6: n=91; SAS 7-9: n=42). The three groups were similar in regards to demographic, functional status and underlying co-morbidities (including coronary artery disease, COPD, diabetes, chronic renal failure). Patients in the lower SAS groups had higher ASA score (p <0.002) and higher Injury Severity Score ( p <0.001). Low SAS scores were associated with significant post-operative morbidity( 77.8 %vs 57.1% vs 45.2 %, p < 0.028 ) and 30-day mortality (29.6% vs 4.4 %vs 2.4%, p <0.001), a prolonged ICU length of stay ( p= 0.001) and hospital LOS (p <0.001).
Conclusion:
The SAS is easily calculated from three routinely available intra-operative measurements. The SAS correlates with fixed pre-operative risk (acute conditions, pre-existing comorbidities, ISS, and operative complexity) and It allows real time assessment of patient morbidity and mortality and may help for better triage of patient to ICU vs PACU setting.
