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


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.


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


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Apgar V (1953) A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg 32:260e7CrossRefGoogle Scholar
  2. 2.
    Knaus WA, Zimmerman JE, Wagner DP et al (1981) APACHE—acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med 9:591–597CrossRefPubMedGoogle Scholar
  3. 3.
    Copeland GP, Jones D, Walters M (1991) POSSUM: a scoring system for surgical audit. BrJ Surg 78:355e60CrossRefGoogle Scholar
  4. 4.
    Campillo-Soto A, Flores-Pastor B, Soria-Aledo V et al (2006) The POSSUM scoring system: an instrument for measuring quality in surgical patients (In Spanish). CirugiaEspanola 80:395e9Google Scholar
  5. 5.
    Gawande AA, Thomas EJ, Zinner MJ et al (1999) The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery 126:66e75CrossRefGoogle Scholar
  6. 6.
    Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ (2007) An Apgar score for surgery. J Am Coll Surg 204:201–208CrossRefPubMedGoogle Scholar
  7. 7.
    Haddow et al (2014) Use of the surgical Apgar score to guide postoperative care. Ann R Coll Surg Engl 96(5):352–335CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Haynes AB, Regenbogen SE, Weiser TG, Lipsitz SR, Dziekan G, Berry WR, Gawande AA (2011 Apr) Surgical outcome measurement for a global patient population: validation of the Surgical Apgar Score in 8 countries. Surgery 149(4):519–524. CrossRefPubMedGoogle Scholar
  9. 9.
    Regenbogen SE, Ehrenfeld JM, Lipsitz SR, Greenberg CC, Hutter MM, Gawande AA (2009) Utility of the surgical Apgar score: validation in 4119 patients. Arch Surg 144(1):30–36CrossRefPubMedGoogle Scholar

Copyright information

© Association of Surgeons of India 2018

Authors and Affiliations

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

Personalised recommendations