Objective: The primary aim of this study was to compare surgical Apgar score (SAS) and time-based modification, modified SAS (mSAS), for predicting postoperative 30-day complications and mortality in major abdominal and orthopedic surgeries.
Methods: This prospective study included 308 patients who underwent major abdominal and orthopedic surgery between June and September 2017 at University of Health Sciences Turkey, Prof. Dr. Cemil Taşcıoğlu City Hospital. SAS was calculated based on estimated blood loss, lowest heart rate, and mean arterial pressure. mSAS was calculated by adding surgical duration to SAS. If the surgical duration >480 min, we added -4 points to the SAS score; 421-480 min, -3 points; 301-420 min, -2 points; 181-300 min, -1 points; and <180 min, 0 points.
Results: The comparison of area under curve (AUCs) revealed that the mSAS had a higher diagnostic accuracy for predicting ICU admission [AUC: 0.680, confidence interval (CI) 95% 0.620-0.738, p<0.001], ventilator support more than 48 h (AUC: 0.791, CI 95% 0.657-0.885, p=0.020), reintubation (AUC: 0.665, CI 95% 0.509-0.813, p=0.025), reoperation (AUC: 0.682, CI 95% 0.580-0.777, p=0.019), pneumonia (AUC: 0.626, CI 95% 0.498-0.747, p<0.001), need for albumin replacement (AUC: 0.712, CI 95% 0.648-0.772, p<0.001), and vasopressor requirement (AUC: 0.640, CI 95% 0.470-0.781, p<0.001) than the SAS.
Conclusion: We suggest that operation time should be added as a simple, objective, and practical parameter to SAS. mSAS might be more effective in predicting postoperative outcomes.