Comparison of Major Complication Rate in High and Low Surgical Apgar Score in Abdominal Surgery Cases

  • Sudarshan Gothwal
  • Anand Mohan
  • Farukh Khan
  • Prabha Om
Original Article
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Abstract

Surgical Apgar score is a simple, objective and economical 10-point post-operative prognostic scoring system based on three readily recorded intraoperative variables. It is calculated at the end of operation from estimated blood loss, lowest mean arterial pressure and lowest heart rate entered in the anaesthesia record during the operation. The score is the sum of points from each category. The score shows a strong correlation with the occurrence of major complications or death within 30 days of surgery. To assess and compare the major complication rate or mortality in high and low surgical Apgar score in abdominal surgery cases. This hospital-based analytical observational study was conducted in year 2015–2016 in upgraded Department of General Surgery SMS Hospital, Jaipur, to compare the complication rate in low surgical Apgar score (SAS < 7) and high SAS (SAS ≥ 7) and formulating the utility of the surgical Apgar score in predicting post-operative outcome. SAS was calculated at the end of the operation from the anaesthetic machine by noting heart rate, mean arterial pressure and estimated blood loss was calculated using the formula:

EBV × (H1 − H2)/{(HcT1 + Hct2)/2} + (500xt)

EBV (estimated blood volume) is assumed to be 70 ml/kg.

H1 and H2 represent preoperative and postoperative haemoglobin.

Hct1 and Hct2 represent preoperative and operative haematocrit.

T is the sum of blood transfused.

The mean lowest heart rate in group A was 81.04 (SD 10.91) per minute and in group B was 67.44 (SD 8.53) per minute. The mean of the lowest mean arterial pressure of the patients in group A was 62.68 (SD 13.44) mmHg and in group B was 78.40 (SD 10.86) mmHg. The mean estimated blood loss (ml) in group A was 367 (SD 396.12) ml and in group B was 156 (SD 154.83) ml. The p value was statistically significant in above mentioned three variables (by applying unpaired t test). Mean surgical Apgar score in group A patients was 4.92 (SD 1.38) and the mean surgical Apgar score in group B was 7.88 (SD 0.88). Data was statistically significant (by applying unpaired t test). Out of 25 patients of group A, 88% had major complication or mortality within 30 days as compared to only 12% in group B. By applying Chi-square test, we found that the difference between the two groups was statistically significant thus highlighting the importance of surgical Apgar score. Amongst group A, patients 76% patients underwent emergency surgery as compared to 48% patients in group B. The mean albumin in group A was 2.8 (SD 0.48) gm/dl and in group B was 3.35 (SD 0.51) gm/dl. These two were statistically significant preoperative factors and determining the outcome of the patient. Surgical Apgar score is a useful parameter to determine the outcome of the patient undergoing laparotomy. The lower the score, the higher the probability of developing major complication.

Keywords

Abdominal surgery Estimated blood loss (EBL) Mean arterial pressure (MAP) Heart rate (HR) Surgical Apgar score (SAS) Standard deviation (SD) 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© Association of Surgeons of India 2018

Authors and Affiliations

  1. 1.Deparment of SurgeryS.M.S Medical College and Hospital Jaipur, RajasthanJaipurIndia

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