title: Surgical Apgar Score predicts an increased risk of major complications and death after renal mass excision.
abstract: OBJECTIVE
  Tailoring perioperative management to minimize the postoperative complication rates depends on reliable prognostication of patients most at risk. The Surgical Apgar Score is an objective measure of the operative course validated to predict major complications and death after general/vascular surgery. We assessed the ability of the Surgical Apgar Score to identify patients most at risk for postoperative morbidity and mortality after renal mass excision.
  
  
  METHODS
  Data for 886 patients undergoing renal mass excision via radical or partial nephrectomy from 2010 to 2013 were extracted from a prospectively collected database. The Surgical Apgar Score was calculated using electronic anesthesia records. Major postoperative complications, readmission and reoperation within 30 days of surgery as well as 90-day mortality were examined.
  
  
  RESULTS
  Overall 13.2% of patients experienced major postoperative complications at 30 days. Clavien grade I, II, III, IV and V complications were experienced by 1.7%, 2.9%, 5.8%, 1.9% and 0.9%, respectively. The 90-day all cause mortality rate was 1.4%. The Surgical Apgar Score was significantly lower in patients experiencing major complications (mean 7.3 vs 7.8, p=0.004) and death (6.3 vs 7.7, p=0.03). Patients with a Surgical Apgar Score of 4 or less were 3.7 times more likely to experience a major complication (p=0.01) and 24 times more likely to die within 90 days of surgery (p=0.0007) compared to patients with a Surgical Apgar Score greater than 8.
  
  
  CONCLUSIONS
  The Surgical Apgar Score is an easily collected metric that can identify patients at higher risk for major complications and death after renal mass excision. A prospective trial to help further delineate the optimal use of this tool in an adjusted perioperative management approach with patients undergoing renal mass excision is warranted.
authors.affiliation: Fox Chase Cancer Center, Philadelphia, Pennsylvania. Electronic address: timothy.ito@fccc.edu.
authors.forename: Timothy
authors.initials: T
authors.lastname: Ito
authors.affiliation: Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Philip H
authors.initials: PH
authors.lastname: Abbosh
authors.affiliation: Department of Urology & Oncological Science, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Reza
authors.initials: R
authors.lastname: Mehrazin
authors.affiliation: Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Tomaszewski
authors.affiliation: Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Tianyu
authors.initials: T
authors.lastname: Li
authors.affiliation: Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Serge
authors.initials: S
authors.lastname: Ginzburg
authors.affiliation: Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Canter
authors.affiliation: Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Greenberg
authors.affiliation: Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Rosalia
authors.initials: R
authors.lastname: Viterbo
authors.affiliation: Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: David Y
authors.initials: DY
authors.lastname: Chen
authors.affiliation: Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutikov
authors.affiliation: Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Smaldone
authors.affiliation: Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
mesh_terms: D001034:Apgar Score; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000401:mortality*; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk
keywords: nephrectomy; postoperative complications