title: Validation of the surgical Apgar score in a neurosurgical patient population.
abstract: OBJECTIVE
  The surgical Apgar score (SAS) reliably predicts postoperative death and complications and has been validated in a large cohort of general and vascular surgery patients. However, there has been limited study of the utility of the score in the neurosurgical population. The authors tested the hypothesis that the SAS would predict postoperative complications and length of stay after neurosurgical procedures.
  
  
  METHODS
  A cohort of 918 intracranial and spine surgery patients treated over a 3-year period were retrospectively evaluated. The 10-point SAS was calculated and postoperative 30-day mortality and complications rates, intensive care unit (ICU) stay, and hospital stay were assessed by 2 independent raters. Univariate analysis and multivariate logistic regression were performed.
  
  
  RESULTS
  There were 145 patients (15.8%) with at least 1 complication and 24 patients (2.6%) who died within 30 days of surgery. Surgical Apgar scores were significantly associated with the likelihood of postoperative complications (p < 0.001) and death (p = 0.002); scores varied inversely with postoperative complication and mortality risk in a multivariate analysis. Low SASs also predicted prolonged ICU and hospital stay. Patients with scores of 0-2 stayed a mean of 18.9 days (p < 0.001) and patients with scores of 3-4 stayed an average of 14.3 days (p < 0.001) compared with 4.1 days in patients with scores of 9-10.
  
  
  CONCLUSIONS
  The application of the surgical Apgar score to a neurosurgical cohort predicted 30-day postoperative mortality and complication rates as well as extended ICU and hospital stay. This readily calculated score may help neurosurgical teams efficiently direct postoperative care to those at highest risk of death and complications.
authors.affiliation: Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Ziewacz
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Davis
authors.forename: Darryl
authors.initials: D
authors.lastname: Lau
authors.forename: Abdulrahman M
authors.initials: AM
authors.lastname: El-Sayed
authors.forename: Scott E
authors.initials: SE
authors.lastname: Regenbogen
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Sullivan
authors.forename: George A
authors.initials: GA
authors.lastname: Mashour
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003399:Craniotomy / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000401:mortality*; D010043:Outcome and Process Assessment, Health Care / Q000379:methods* / Q000592:standards*; D011183:Postoperative Complications / Q000401:mortality*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors