title: Perioperative risk assessment for gastrectomy by surgical apgar score.
abstract: BACKGROUND
  Recently, a simple and easy complication prediction system, the surgical apgar score (SAS) calculated by three intraoperative parameters (estimated blood loss, lowest mean arterial pressure, and lowest heart rate), has been proposed for general surgery. In this study, we evaluated the predictability of the original SAS (oSAS) for severe complications after gastrectomy. In addition, the predictability of a modified SAS (mSAS) was evaluated, in which the cutoff value for blood loss was slightly modified.
  
  
  METHODS
  We investigated 328 patients who underwent gastrectomy at the Shizuoka Cancer Center in 2010. Clinical data, including intraoperative parameters, were collected retrospectively. Patients with postoperative morbidities classified as Clavien-Dindo grade IIIa or more were defined as having severe complications. Univariate and multivariate analyses were performed to elucidate factors that affected the development of severe complications.
  
  
  RESULTS
  Thirty-six patients (11.0 %) had severe complications postoperatively. Univariate analyses showed that the oSAS (p = 0.007) and mSAS (p < 0.001), as well as sex, preoperative chemotherapy, cStage, type of operation, thoracotomy, surgical approach, operation time, and extent of lymph node dissection, were associated with severe complications. Multivariate analysis showed that an mSAS ≤6 was found to be an independent risk factor for severe complication, while an oSAS ≤6 was not.
  
  
  CONCLUSIONS
  The oSAS was not found to be a predictive factor for severe complications following gastrectomy in Japanese patients. A slightly modified SAS (i.e. the mSAS) is considered to be a useful predictor for the development of severe complications in elective surgery.
authors.affiliation: Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Miki
authors.forename: Masanori
authors.initials: M
authors.lastname: Tokunaga
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tanizawa
authors.forename: Etsuro
authors.initials: E
authors.lastname: Bando
authors.forename: Taiichi
authors.initials: T
authors.lastname: Kawamura
authors.forename: Masanori
authors.initials: M
authors.lastname: Terashima
mesh_terms: D000368:Aged; D001034:Apgar Score; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008297:Male; D009367:Neoplasm Staging; D059035:Perioperative Period; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*