Surgical Apgar score predicts perioperative morbidity in patients undergoing pancreaticoduodenectomy at a high-volume center.
OBJECTIVE
Pancreaticoduodenectomy (PD) remains a procedure that carries considerable morbidity. Numerous studies have evaluated factors to predict patients at risk. The aim of this study was to determine whether the surgical Apgar score (SAS) predicts perioperative morbidity and mortality.


METHODS
We examined 553 patients undergoing successful PD between January 2000 and December 2010. Postoperative complications were graded using the Clavien scale, and the SAS (range, 0-10) was determined. The Cochran-Armitage test for trend was used to determine the association between grouped SAS scores (0-2, 3-4, 5-6, 7-8, and 9-10) and each of the outcomes.


RESULTS
The average patient age was 64 years, and there was an even distribution of males and females. There were 11 perioperative deaths (2%), 186 grade 2 or higher complications (34%), and 86 major complications (grades 3-5, 16%). Additionally, 61 patients developed pancreatic fistulae (11%). Statistical analysis determined that SAS was a significant predictor of grade 2 or higher complications (p < 0.0001), major morbidity (p = 0.01), and pancreatic fistula (p = 0.04) but not mortality (p = 0.20).


CONCLUSIONS
We demonstrate that the SAS is a significant predictor of perioperative morbidity for patients undergoing PD. This score should be used to identify patients at higher risk in order to prioritize use of postoperative critical care beds and hospital resources.
Department of Surgery and Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, 1100 Walnut Street, MOB, Suite 500, Philadelphia, PA 19107, USA.
M Mura
MM
Assifi
John
J
Lindenmeyer
Benjamin E
BE
Leiby
Zvi
Z
Grunwald
Ernest L
EL
Rosato
Eugene P
EP
Kennedy
Charles J
CJ
Yeo
Adam C
AC
Berger
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001794:Blood Pressure; D015331:Cohort Studies; D003661:Decision Support Techniques; D005260:Female; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000401:mortality; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D055815:Young Adult