title: The surgical Apgar score is strongly associated with intensive care unit admission after high-risk intraabdominal surgery.
abstract: BACKGROUND
  Understanding intensive care unit (ICU) triage decisions for high-risk surgical patients may ultimately facilitate resource allocation and improve outcomes. The surgical Apgar score (SAS) is a simple score that uses intraoperative information on hemodynamics and blood loss to predict postoperative morbidity and mortality, with lower scores associated with worse outcomes. We hypothesized that the SAS would be associated with the decision to admit a patient to the ICU postoperatively.
  
  
  METHODS
  We performed a retrospective cohort study of adults undergoing major intraabdominal surgery from 2003 to 2010 at an academic medical center. We calculated the SAS (0-10) for each patient based on intraoperative heart rate, mean arterial blood pressure, and estimated blood loss. Using logistic regression, we assessed the association of the SAS with the decision to admit a patient directly to the ICU after surgery.
  
  
  RESULTS
  The cohort consisted of 8501 patients, with 72.7% having an SAS of 7 to 10 and <5% an SAS of 0 to 4. A total of 8.7% of patients were transferred immediately to the ICU postoperatively. After multivariate adjustment, there was a strong association between the SAS and the decision to admit a patient to the ICU (adjusted odds ratio 14.41 [95% confidence interval {CI}, 6.88-30.19, P < 0.001] for SAS 0-2, 4.42 [95% CI, 3.19-6.13, P < 0.001] for SAS 3-4, and 2.60 [95% CI, 2.08-3.24, P < 0.001] for SAS 5-6 compared with SAS 7-8).
  
  
  CONCLUSIONS
  The SAS is strongly associated with clinical decisions regarding immediate ICU admission after high-risk intraabdominal surgery. These results provide an initial step toward understanding whether intraoperative hemodynamics and blood loss influence ICU triage for postsurgical patients.
authors.affiliation: Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, 622 West 168th St., New York, NY 10032, USA. jbs2005@columbia.edu
authors.forename: Julia B
authors.initials: JB
authors.lastname: Sobol
authors.forename: Hayley B
authors.initials: HB
authors.lastname: Gershengorn
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
authors.forename: Guohua
authors.initials: G
authors.lastname: Li
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D016063:Blood Loss, Surgical / Q000401:mortality; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D010360:Patient Transfer; D010808:Physical Examination / Q000379:methods*; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014218:Triage / Q000379:methods*