title: An assessment of the Surgical Apgar Score in spine surgery.
abstract: BACKGROUND
  The Surgical Apgar Score (SAS), a simple metric based on intraoperative heart rate, blood pressure, and blood loss, was developed in general and vascular surgery to predict 30-day major postoperative complications and mortality. No validation of SAS has been performed in spine surgery.
  
  
  OBJECTIVE
  To perform a prospective assessment of SAS in spine surgery.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Two hundred sixty-eight consecutive patients undergoing major and intermediate spinal surgeries in an 18-month period.
  
  
  METHODS
  Occurrence of major complications or death within 30 days of surgery.
  
  
  METHODS
  Intraoperative parameters were registered, and SAS was calculated immediately after surgery. Outcome data were collected during a 30-day follow-up. The relationship between SAS and the outcomes was analyzed calculating relative risks (RRs) and likelihood ratios (LRs) for different scoring groups. A univariate logistic regression analysis was also performed. The discriminatory accuracy of SAS was evaluated calculating a C-statistic.
  
  
  RESULTS
  Eighteen patients had ≥1 complications (6.72%). Patients with SAS 9-10 exhibited a 1.64% complication rate (RR=1; LR=0.23), which monotonically augmented as the score decreased: (SAS 7-8=2.75%; RR=1.68; LR=0.39), (SAS 5-6=13.33%; RR=8.13; LR=2.14), (SAS≤4=17.39%; RR=10.61; LR=2.92). The regression analysis odds ratio was 0.66 (95% confidence interval, 0.54-0.82), p<.01. The C-statistic was 0.77 (95% confidence interval, 0.66-0.88).
  
  
  CONCLUSIONS
  Surgical Apgar Score allows risk stratification and has a good discriminatory power in patients undergoing spine surgery.
authors: Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile. Electronic address: jurrutia@med.puc.cl.
authors: Julio
authors: J
authors: Urrutia
authors: Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile.
authors: Macarena
authors: M
authors: Valdes
authors: Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile.
authors: Tomas
authors: T
authors: Zamora
authors: Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile.
authors: Valentina
authors: V
authors: Canessa
authors: Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile.
authors: Jorge
authors: J
authors: Briceno
mesh_terms: D016063:Blood Loss, Surgical; D001794:Blood Pressure / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods*; D011446:Prospective Studies; D013131:Spine / Q000601:surgery*
keywords: Patient outcome assessment; Postoperative complications; Surgical Apgar Score