title: Use of the surgical Apgar score to enhance Veterans Affairs Surgical Quality Improvement Program surgical risk assessment in veterans undergoing major intra-abdominal surgery.
abstract: BACKGROUND
  We investigated whether the surgical Apgar score (SAS) may enhance the Veterans Affairs Surgical Quality Improvement Program (VASQIP) risk assessment for prediction of early postoperative outcomes.
  
  
  METHODS
  We retrospectively evaluated demographics, medical history, procedure, SAS, VASQIP assessment, and postoperative data for patients undergoing major/extensive intra-abdominal surgery at the Manhattan Veterans Affairs between October 2006 and September 2011. End points were overall morbidity and 30-, 60- , and 90-day mortality. Pearson's chi-square, ANOVA, and multivariate regression modeling were employed.
  
  
  RESULTS
  Six hundred twenty-nine patients were included. Apgar groups did not differ in age, sex, and race. Low SASs were associated with worse functional status, increased postoperative morbidity, and 30-, 60- , and 90-day mortality rates. SAS did not significantly enhance VASQIP prediction of postoperative outcomes, although a trend was detected. Multivariate analysis confirmed SAS as an independent predictor of morbidity and mortality.
  
  
  CONCLUSIONS
  SAS effectively identifies veterans at high risk for poor postoperative outcome. Additional studies are necessary to evaluate the role of SAS in enhancing VASQIP risk prediction.
authors: Department of Surgery, New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010, USA; Department of Surgery, NYU School of Medicine, New York, 550 1st Avenue, New York, NY 10016, USA.
authors: Antonio
authors: A
authors: Masi
authors: Department of Surgery, NYU School of Medicine, New York, 550 1st Avenue, New York, NY 10016, USA.
authors: Salvatore
authors: S
authors: Amodeo
authors: Department of Surgery, NYU School of Medicine, New York, 550 1st Avenue, New York, NY 10016, USA.
authors: Ioannis
authors: I
authors: Hatzaras
authors: Department of Surgery, New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010, USA; Department of Surgery, NYU School of Medicine, New York, 550 1st Avenue, New York, NY 10016, USA; Department of General Surgery - Clinica Chirurgica, University of Sassari, Sassari, Italy.
authors: Antonio
authors: A
authors: Pinna
authors: Section of Gastroenterology and Medicine Program Mount Sinai School of Medicine and James J. Peters VAMC, NY, USA.
authors: Alan S
authors: AS
authors: Rosman
authors: Department of Surgery, NYU School of Medicine, New York, 550 1st Avenue, New York, NY 10016, USA.
authors: Steven
authors: S
authors: Cohen
authors: Department of Surgery, New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010, USA; Department of Surgery, NYU School of Medicine, New York, 550 1st Avenue, New York, NY 10016, USA.
authors: John K
authors: JK
authors: Saunders
authors: Department of Surgery, NYU School of Medicine, New York, 550 1st Avenue, New York, NY 10016, USA.
authors: Russell
authors: R
authors: Berman
authors: Department of Surgery, New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010, USA; Department of Surgery, NYU School of Medicine, New York, 550 1st Avenue, New York, NY 10016, USA.
authors: Elliot
authors: E
authors: Newman
authors: Department of Surgery, New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010, USA; Department of Surgery, NYU School of Medicine, New York, 550 1st Avenue, New York, NY 10016, USA.
authors: Garth H
authors: GH
authors: Ballantyne
authors: Department of Surgery, NYU School of Medicine, New York, 550 1st Avenue, New York, NY 10016, USA.
authors: Leon H
authors: LH
authors: Pachter
authors: Department of Surgery, New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010, USA; Department of Surgery, NYU School of Medicine, New York, 550 1st Avenue, New York, NY 10016, USA. Electronic address: marcovalerio.melis@nyumc.org.
authors: Marcovalerio
authors: M
authors: Melis
mesh_terms: D034841:Abdominal Cavity / Q000601:surgery; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D035423:Thoracic Cavity / Q000601:surgery; D014481:United States / Q000453:epidemiology; D014728:Veterans
keywords: Alimentary tract; Major Surgery; Surgical Apgar score