"Surgical Apgar Score" predicts postoperative complications after cytoreduction for advanced ovarian cancer.
OBJECTIVE
A 10-point "Surgical Apgar Score" (SAS) for predicting postoperative complications after general and vascular operations has recently been developed and validated. We sought to estimate the ability of this metric to predict major postoperative complications in women undergoing ovarian cancer cytoreductive procedures.


METHODS
All eligible patients with stage III and IV epithelial ovarian, fallopian tube and primary peritoneal cancer undergoing surgical cytoreduction at our institution between 1999 and 2005 were included. Medical records were reviewed and demographic data, clinicopathologic characteristics, comorbidities and intra and postoperative complications were analyzed. The surgical score was calculated from intraoperative blood loss, lowest mean arterial pressure and lowest heart rate as previously described. Descriptive statistics, univariable and multivariable analyses were used as appropriate. Occurrence of major postoperative complications represented the primary outcome.


RESULTS
A total of 232 cases were analyzed. Mean age was 62 years. Most patients were Caucasian (92%) and diagnosed with stage III disease (83%). Mean duration of surgical procedure was 171 (70-350) minutes. Median SAS was 6 points (range 1-9). On multivariable analyses, occurrence of major postoperative complications was associated with multiple comorbidities (OR 2.2; 95% CI:1.5-3.1; p<0.0001), stage IV disease (OR 2.5; 95% CI:1.1-5.7; p=0.03), ASA class (OR 2.4; 95% CI:1.2-4.7; p=0.01) and SAS<or=4 (OR 7.4; 95% CI:2.9-18.8; p<0.0001).


CONCLUSIONS
Lower SAS (<or=4) is the most powerful predictor of postoperative complications in patients undergoing cytoreductive surgery for advanced epithelial ovarian cancer. This prognostic tool may prove helpful for triaging such patients to optimal postoperative levels of care and directing counseling, monitoring and management in the postoperative period.
Zighelboim
Israel
I
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, 4911 Barnes Jewish Hospital Plaza, St. Louis, MO 63110, USA. zighelboimi@wustl.edu
Kizer
Nora
N
Taylor
Nicholas P
NP
Case
Ashley S
AS
Gao
Feng
F
Thaker
Premal H
PH
Rader
Janet S
JS
Massad
L Stewart
LS
Mutch
David G
DG
Powell
Matthew A
MA
D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods