title: The Surgical Apgar Score in esophagectomy.
abstract: OBJECTIVE
  The Surgical Apgar Score is a validated prognostic tool that is based on select intraoperative variables (heart rate, mean arterial pressure, and blood loss). It has been shown to be a strong predictor of morbidity and mortality in a variety of surgical populations. Esophagectomy for malignancy represents a unique subset of patients at high risk for postoperative complications. This study assessed the ability of a modified esophagectomy Surgical Apgar Score (eSAS) to predict 30-day major morbidity.
  
  
  METHODS
  A retrospective review included 168 patients who underwent elective esophagectomy for malignant disease at the University of Wisconsin from January 2009 through July 2013. Preoperative patient characteristics, intraoperative details, and short-term outcomes were recorded. Primary outcome was 30-day major morbidity. Univariate and multivariate analyses were performed to determine associations between predictive variables, eSAS, and major morbidity.
  
  
  RESULTS
  Major morbidity occurred in 35% of cases. Univariate analysis showed that eSAS of 6 or less was strongly associated with major morbidity (unadjusted odds ratio, 2.55; 95% confidence interval, 1.32-4.91; P = .005). Other risk factors included transhiatal technique, body mass index less than 20 or greater than 35 kg/m(2), and history of diabetes mellitus. In multivariate analysis, eSAS of 6 or less remained a strong predictor of postoperative complications (adjusted odds ratio, 3.75; 95% confidence interval, 1.70-8.26; P = .001).
  
  
  CONCLUSIONS
  The eSAS was strongly associated with 30-day major morbidity after esophagectomy. Prospective studies are needed to determine whether improved outcomes can be achieved with the eSAS for risk-stratified triage and postoperative care modification.
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Janowak
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Justin D
authors.initials: JD
authors.lastname: Blasberg
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Lauren
authors.initials: L
authors.lastname: Taylor
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: James D
authors.initials: JD
authors.lastname: Maloney
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis. Electronic address: macke@surgery.wisc.edu.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Macke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001794:Blood Pressure; D016629:Esophagectomy; D005260:Female; D006339:Heart Rate; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
keywords: esophageal carcinoma; esophagectomy; risk prediction