Can Surgical Apgar Score (SAS) Predict Postoperative Complications in Patients Undergoing Gynecologic Oncological Surgery?
Surgeons constantly try to achieve optimal surgical outcome, number, or extent of postoperative complications being an important part of it. Oncological surgeries are conventionally more challenging and complex compared with most nononcological ones. Gawande et al. devised SAS in 2007 in Boston as a predictor tool for postoperative complications (J Am Coll Surg 204:201–208, 2007). A validation study was done by in another cohort of 100 patients; however, only 70% of them had pathologically confirmed malignancies (Ann Surg 240(2):205–213, 2004). We attempt to assess SAS as a tool to predict postoperative complications in a series of 100 gynecological oncological patients operated at tertiary care center. SAS score of 100 patients with gynecologic malignancies, undergoing surgery at a tertiary care center, was prospectively collected over 4 years. These patients were observed for development of any complications occurring up to 30 days postsurgery. The complication events were graded as per Clavien-Dindo classification (Indian J Gynecol Oncolog 15:49, 2017). The data obtained was statistically analyzed by chi-square test. Thirty complication events were recorded in these 100 patients over a period of 4 years. Majority of complication events were grade IIIa or less (22 out of 30); there was only one death on 8th postoperative day. Fifty percent of patients were with SAS score of 5 or less developed complications compared with just 22.9% in patients with a score of 6 or more. Lower SAS score might be associated with higher postoperative complications in patients undergoing gynecologic oncological surgeries. Thus, patients with lower scores may benefit from a triage to more intensive postoperative care.
KeywordsSurgical Apgar score Gynecological malignancy Postoperative complications Clavien Dindo grading
Prashant Bhandarkar, Medical Statistician, BARC Hospital, Mumbai—for statistical analysis and support. Department of Anesthesiology & Critical Care, The Gujarat Cancer & Research Hospital, Ahmedabad and Command Hospital, Pune—for peri-operative care and support.
Compliance with Ethical Standards
The study was approved by the Institute Ethical committee. An informed consent was obtained for all patients included in study.
Conflicts of Interest
The authors declare that they have no conflict of interest.
- 15.Santoshsingh SR, Sathyakrishna BR (2016) Surgical Apgar score - a simple prognostic tool in surgery. Int J Sci Stud 4(4):1–5Google Scholar
- 16.Haddow JB, Adwan H, Clark SE, Tayeh S, Antonowicz SS, Jayia P, Chicken DW, Wiggins T, Davenport R, Kaptanis S, Fakhry M, Knowles CH, Elmetwally AS, Geddoa E, Nair MS, Naeem I, Adegbola S, Muirhead LJ (2014) London Surgical Research Group. Use of the surgical Apgar score to guide postoperative care. Ann R Coll Surg Engl 96:352–335CrossRefGoogle Scholar