title: Surgical apgar outcome score: perioperative risk assessment for radical cystectomy.
abstract: OBJECTIVE
  Currently objective perioperative risk assessment metrics are lacking for radical cystectomy. Using a simple 10-point scale similar to neonatal Apgar assessment we evaluated whether a surgical outcome score calculated immediately after radical cystectomy would predict major complications and mortality.
  
  
  METHODS
  We identified 155 consecutive radical cystectomies performed between 2005 and 2007 at our institution. Data were collected on 45 preoperative and intraoperative variables. We used a framework established by the National Surgical Quality Improvement Program to evaluate major complications within 30 days of surgery. We used a 10-point scoring system that had been previously validated in general and vascular surgery populations, comprising estimated blood loss, lowest heart rate and lowest mean arterial pressure.
  
  
  RESULTS
  A total of 40 (26%) patients undergoing radical cystectomy experienced a major complication within 30 days of the operation. There was a progressive decrease in complications with increasing surgical Apgar score, in that patients with a low vs a high Apgar score were more likely to experience complications (OR 6.9, 95% CI 1.9-24.2). Coronary artery disease, American Society of Anesthesiologists class, intraoperative blood transfusion, volume of intravenous fluid administered and female gender were also associated with major complications (p <0.05).
  
  
  CONCLUSIONS
  In patients undergoing radical cystectomy the surgical Apgar score predicts major postoperative complications and death. This simple and objective postoperative metric may be used to dictate the intensity of care. Prospective studies are needed to determine whether treatment decisions based on this scoring system improve radical cystectomy outcomes.
authors.affiliation: Division of Urologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Sandip M
authors.initials: SM
authors.lastname: Prasad
authors.forename: Marcos
authors.initials: M
authors.lastname: Ferreria
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Berry
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Jerome P
authors.initials: JP
authors.lastname: Richie
authors.forename: Atul A
authors.initials: AA
authors.lastname: Gawande
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D011379:Prognosis; D018570:Risk Assessment; D001749:Urinary Bladder Neoplasms / Q000601:surgery*