title: Implementing the Surgical Apgar Score in patients with trauma hip fracture.
abstract: BACKGROUND
  Trauma hip fractures in elderly patients are associated with high postoperative long-term morbidity and mortality and premature death. The high mortality in these patients can be explained by various factors, including the fracture itself; the preoperative poor condition and comorbidities of these patients; the influence of stressors, such as surgery and type of anaesthesia, on the patient's condition; and the postoperative development of major complications, such as cardiac failure, pulmonary embolism, pneumonia, deep venous thrombosis and acute renal failure. Thus, the Surgical Apgar Score (SAS) could be a valuable tool for objective risk stratification of patients immediately after surgery, and to enable patients with higher risk to receive postoperative ICU care and good management both during and after the hospital stay.
  
  
  METHODS
  The SAS was calculated retrospectively from the handwritten anaesthesia records of 43 trauma hip fracture patients treated operatively in the University Hospital Centre Zagreb over a 1-year period. The primary endpoints were the 30-days major postoperative complications and mortality, length of the ICU and hospital stay, and 6-months major complications development. Statistical analysis was applied to compare SAS with the patients' perioperative variables.
  
  
  RESULTS
  A SAS≤4 in the trauma hip fracture patients was a significant predictor for the 30-days major postoperative complications with 80% specificity (95% CI: 0.587-0.864, p=0.0111). However, the SAS was not significant in the prediction of 30-days mortality (95% CI: 0.468-0.771, p=0.2238) and 6-months mortality (95% CI: 0.497-0.795, p=0.3997) as primary endpoints in the hip fracture surgery patients.
  
  
  CONCLUSIONS
  The SAS shows how intraoperative events affect postoperative outcomes. Calculating the SAS in the operating theatre provides immediate, reliable, real-time feedback information about patient postoperative risk. The results of this study indicate that all trauma hip fracture patients with SAS≤4 should go to the ICU postoperatively and should be under intensive surveillance both during the hospital stay and after hospital discharge.
authors.affiliation: Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia. Electronic address: sanja.sakan@hotmail.com.
authors.forename: Sanja
authors.initials: S
authors.lastname: Sakan
authors.affiliation: Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Daniela Bandic
authors.initials: DB
authors.lastname: Pavlovic
authors.affiliation: School of Public Health "Andrija Stampar", School of Medicine University of Zagreb, Zagreb, Croatia.
authors.forename: Milan
authors.initials: M
authors.lastname: Milosevic
authors.affiliation: Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Igor
authors.initials: I
authors.lastname: Virag
authors.affiliation: Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Petar
authors.initials: P
authors.lastname: Martinovic
authors.affiliation: Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Dobric
authors.affiliation: Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Slavko
authors.initials: S
authors.lastname: Davila
authors.affiliation: Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Mladen
authors.initials: M
authors.lastname: Peric
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D017523:Croatia / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality*; D006620:Hip Fractures / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010808:Physical Examination / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality*; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D020246:Venous Thrombosis / Q000209:etiology / Q000401:mortality*
keywords: Anaesthesia; Hip fracture; Intensive care; Surgical Apgar Score; Surgical outcome; Trauma