Philippine Journal of Surgical Specialties Vol. 66, No. 2, April-June, 2011, pp 45-51

Validation of the Surgical APGAR Score Among Patients Undergoing Major Surgery at the Chinese General Hospital

Author(s): Stewart S. Santos, M.D.; Noruel Gerard A. Salvador, M.D.; Maila Rose L. Torillo, M.D.; Blas Anthony M. Yu, M.D. and Yemen D. Kadatuan, M.D.

Surgery does not have a routine reliable objective evaluation of patient condition after surgery to determine postoperative prognostication and to guide clinical practice. Surgical APGAR score is a 10-point score based on a patient’s intraoperative estimated blood loss, lowest heart rate and lowest mean arterial pressure that can predict major complications 30 days after surgery.

This study sought to validate Surgical APGAR Score in predicting major postoperative complications 30 days after surgery in our hospital setting.

All patients undergoing major general surgery in Chinese General Hospital and Medical Center from March to October 2009 were enrolled. Three intraoperative variables were measured: estimated blood loss (EBL), lowest mean arterial pressure (LMAP) and lowest heart rate (LHR). Based on these 3 variables, Surgical APGAR Scores were obtained. Resulting data were analyzed and the relationship between the scores and the incidence of major complications evaluated.

Eighty patients were enrolled in this study. There was a significant association of incidence of major complications and decreasing surgical APGAR score (Fisher’s exact test, P=0.030). With increasing scores, the incidence of major complications decreased monotonically. The optimum cutoff point for Surgical scores was ≤6. At this cutoff point, sensitivity was 80%, specificity was 78.57%, positive predictive value was low at 34.8%, while negative predictive value was high at 96.5%.

Results showed that a simple surgical score can be derived from intraoperative data alone that are readily available. It validated that this 10-point scoring system based on estimated blood loss (EBL), lowest mean arterial pressure (LAMP) and lowest heart rate (LHR) can predict group of patients at higher risk of major complications within 30 days of surgery. This system can be a significant tool for prognostication and clinical guide for early intervention of postoperative care in surgery.

Key words: estimated blood loss, lowest mean arterial pressure