Surgical Apgar score (SAS) predicts the risk of major complications by calculating the lower mean blood pressure, lower heart rate, and amount of blood loss. SAS is convenient for its simple factors; however, this score is too unspecific for use in all surgery types. Therefore, specific risk factors should be considered for each surgical field. In this study, we modified SAS by adding some factors and examining their relationships with major complications after gastrectomy.
We retrospectively evaluated intraoperative factors from 237 patients who underwent gastrectomy for gastric cancer at the Keiyu Hospital, Kanagawa, Japan. We divided the patients into two groups: one group had major complications of grade III, IV, or V of the Clavien–Dindo classification system within 30 days after gastrectomy, whereas the other group had no major complications. We set new surgical scores for gastrectomy and modified SAS by two additional factors, blood loss that was just revised about the scoring system and operative time. We set cutoff values of 6 points in the conventional SAS and 10 points in the new SAS as calculated by receiver operating characteristic curves.
Twenty-eight patients (11.8%) were assigned to the complications group. Univariable analysis on the intraoperative factors revealed significant differences between the two groups for the factors of operative time (p = 0.032), blood loss (p = 0.002), length of postoperative hospital stay (p < 0.0001), and new SAS < 10 (p = 0.006). Multivariable analysis revealed significant differences between the two groups for two factors: total gastrectomy (hazard ratio, 3.11; 95% confidence interval, 1.26–7.68, p = 0.014) and new SAS ≥ 10 (hazard ratio, 0.40; 95% confidence interval, 0.17–0.97, p = 0.044); no significant differences were determined for SAS ≥ 6 or not.
In our study, the new SAS is more useful for predicting major postoperative complications after gastrectomy for gastric cancer than conventional SAS. Moreover, modification of SAS using specific risk factors according to the surgery type is required.
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All authors have declared no conflicts of interest.