SURGICAL APGAR SCORE AS A GUIDE FOR PREDICTING POSTOPERATIVE ICU ADMISSIONS

Introduction: Immediate planned and appropriate postoperative intensive care unit (ICU) admission can increase the survival rate in patients undergoing high risk surgeries. Surgical Apgar Score is a simple, 10-point scoring system in which a low score reliably identifies those patients at risk for adverse perioperative outcomes. It can predict 30-day major complications or death after surgery. The aim of the present study was to evaluate the performance of the SAS for predicting complications 30 days after surgery in patients undergoing laparotomy surgeries Methods: Total 50 patients undergoing laparotomies and emergency surgeries were included in the study. Outcome data were collected after 30 days during an outpatient consultation. The following intraoperative data were extracted from the anesthesia information management system and used to calculate the SAS: maximum estimated blood loss (EBL), lowest mean arterial pressure (MAP), and lowest heart rate (HR) (all intraoperative parameters) Results: Our study was conducted on a total 50 patients, mean age of the patients in our study was 47.9%, among the study 58.5% were female, 91% underwent elective surgery. Majority of cases belong to ASA class II( 62%). In our study 8% of population were transferred directly to ICU following surgery. In our study males were more likely to be admitted to ICU postoperatively than females (11.3%). And patients undergoing emergency surgeries were more likely to be admitted in ICU than elective surgeries. Patients were ASA grade III and IV have more chances of ICU admission. AGE DISTRIBUTION IMMEDIATE ICU ADMISSION <50 51.6% 4.1% 50-59 17.2% 8.1% 60-69 16.7% 13% 70-79 9.6% 12.4% >80 5% 18.6% SEX DISTRIBUTION: SEX PERCENTAGE ICU ADMISSION MALE 41.5% 11.3% FEMALE 58.5% 5.2% Conclusion: SAS is an effective, simple score which is a practical and objective instrument that provides immediate feedback for predicting postoperative ICU admissions. Factors associated with a higher frequency of ICU admission are older age, male sex, emergency surgery, higher ASA class. Most patients had SAS of 7-8%(49.1%) and 9 -10 (19.3%). 86% of the cases had a ASA > 3. Patient with SAS of 0-2(46.2%) and 3-4(17%)were admitted post operatively directly to ICU References: 1.Vincent C, Moorthy K, Sarker SK, et al. Systems approaches to surgical quality and safety: from concept to measurement. Ann Surg. 2004239(4):475-82. [PMC free article] [PubMed] 2. Fink AS, Campbell DA, Jr, Mentzer RM, Jr, et al. The National Surgical Quality Improvement Program in non-veterans administration hospitals: initial demonstration of feasibility. Ann Surg. 2002236(3):344-53. discussion 353-4. [PMC free article] [PubMed] 3. Khuri SF, Daley J, Henderson W, et al. The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg. 1995180(5):519-31. [PubMed] 4. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993 270: 2,957 2,963. [PubMed] 5. Barnett S, Moonesinghe SR. Clinical risk scores to guide perioperative management. Postgrad Med J 2011 87: 535-541. [PubMed] 6. Gawande AA, Kwaan MR, Regenbogen SE et al An Apgar score for surgery. J Am Coll Surg 2007 204: 201-208. [PubMed].