Validation of the surgical Apgar score in a neurosurgical patient population

Clinical article

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  • 1 Departments of Neurosurgery,
  • 4 General Surgery, and
  • 5 Anesthesiology, University of Michigan Medical School;
  • 2 University of Michigan Medical School, Ann Arbor, Michigan; and
  • 3 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Object

The surgical Apgar score (SAS) reliably predicts postoperative death and complications and has been validated in a large cohort of general and vascular surgery patients. However, there has been limited study of the utility of the score in the neurosurgical population. The authors tested the hypothesis that the SAS would predict postoperative complications and length of stay after neurosurgical procedures.

Methods

A cohort of 918 intracranial and spine surgery patients treated over a 3-year period were retrospectively evaluated. The 10-point SAS was calculated and postoperative 30-day mortality and complications rates, intensive care unit (ICU) stay, and hospital stay were assessed by 2 independent raters. Univariate analysis and multivariate logistic regression were performed.

Results

There were 145 patients (15.8%) with at least 1 complication and 24 patients (2.6%) who died within 30 days of surgery. Surgical Apgar scores were significantly associated with the likelihood of postoperative complications (p < 0.001) and death (p = 0.002); scores varied inversely with postoperative complication and mortality risk in a multivariate analysis. Low SASs also predicted prolonged ICU and hospital stay. Patients with scores of 0–2 stayed a mean of 18.9 days (p < 0.001) and patients with scores of 3–4 stayed an average of 14.3 days (p < 0.001) compared with 4.1 days in patients with scores of 9–10.

Conclusions

The application of the surgical Apgar score to a neurosurgical cohort predicted 30-day postoperative mortality and complication rates as well as extended ICU and hospital stay. This readily calculated score may help neurosurgical teams efficiently direct postoperative care to those at highest risk of death and complications.

Abbreviations used in this paper:ASA = American Society of Anesthesiologists; BMI = body mass index; CAD = coronary artery disease; ICU = intensive care unit; SAS = surgical Apgar score.

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Contributor Notes

Address correspondence to: George A. Mashour, M.D., Ph.D., University of Michigan, Departments of Anesthesiology and Neurosurgery, 1H247 University Hospital, SPC 5048, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109. email: gmashour@med.umich.edu.

Please include this information when citing this paper: published online November 2, 2012; DOI: 10.3171/2012.10.JNS12436.

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