The Surgical Apgar Score in esophagectomy

ObjectiveThe Surgical Apgar Score is a validated prognostic tool that is based on select intraoperative variables (heart rate, mean arterial pressure, and blood loss). It has been shown to be a strong predictor of morbidity and mortality in a variety of surgical populations. Esophagectomy for malignancy represents a unique subset of patients at high risk for postoperative complications. This study assessed the ability of a modified esophagectomy Surgical Apgar Score (eSAS) to predict 30-day major morbidity.MethodsA retrospective review included 168 patients who underwent elective esophagectomy for malignant disease at the University of Wisconsin from January 2009 through July 2013. Preoperative patient characteristics, intraoperative details, and short-term outcomes were recorded. Primary outcome was 30-day major morbidity. Univariate and multivariate analyses were performed to determine associations between predictive variables, eSAS, and major morbidity.ResultsMajor morbidity occurred in 35% of cases. Univariate analysis showed that eSAS of 6 or less was strongly associated with major morbidity (unadjusted odds ratio, 2.55; 95% confidence interval, 1.32-4.91; P = .005). Other risk factors included transhiatal technique, body mass index less than 20 or greater than 35 kg/m2, and history of diabetes mellitus. In multivariate analysis, eSAS of 6 or less remained a strong predictor of postoperative complications (adjusted odds ratio, 3.75; 95% confidence interval, 1.70-8.26; P = .001).ConclusionsThe eSAS was strongly associated with 30-day major morbidity after esophagectomy. Prospective studies are needed to determine whether improved outcomes can be achieved with the eSAS for risk-stratified triage and postoperative care modification.