title: Prediction of Outcome After Emergency High-Risk Intra-abdominal Surgery Using the Surgical Apgar Score.
abstract: With current literature quoting mortality rates up to 45%, emergency high-risk abdominal surgery has, compared with elective surgery, a significantly greater risk of death and major complications. The Surgical Apgar Score (SAS) is predictive of outcome in elective surgery, but has never been validated exclusively in an emergency setting.
  
  
  
  A consecutive prospective single-center cohort study of 355 adults undergoing emergency high-risk abdominal surgery between June 2013 and May 2014 is presented. The primary outcome measure was 30-day mortality. Secondary outcome measures were postoperative major complications, defined according to the Clavien-Dindo scale as well as the American College of Surgeons' National Surgical Quality Improvement Program guidelines, and intensive care unit admission. The SAS was calculated postoperatively. Cochran-Armitage test for trend was used to evaluate the incidence of both outcomes. Area under the curve was used to demonstrate the scores' discriminatory power.
  
  
  
  One hundred eighty-one (51.0%) patients developed minor or no complications. The overall incidence of major complications was 32.7% and the overall death rate was 16.3%. Risk of major complications, death, and intensive care unit admission increased significantly with decreasing SAS (P < .001). The score's c-statistics were 0.63.
  
  
  
  We have demonstrated the SAS to be significantly predictive but weakly discriminative for major complications and death among adults undergoing emergency high-risk abdominal surgery. Despite its predictive value, the SAS cannot in its current version be recommended as a standalone prognostic tool in an emergency setting.
authors: From the Departments of *Gastrointestinal Surgery and †Anaesthesiology and Intensive Care Medicine, Hvidovre University Hospital, Copenhagen, Denmark.
authors: Mirjana
authors: M
authors: Cihoric
authors: Line
authors: L
authors: Toft Tengberg
authors: Morten
authors: M
authors: Bay-Nielsen
authors: Nicolai
authors: N
authors: Bang Foss
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003661:Decision Support Techniques; D003718:Denmark / Q000453:epidemiology; D004630:Emergencies; D005260:Female; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult