title: Association between the Surgical Apgar Score and Perioperative Complications after Radical Prostatectomy.
abstract: OBJECTIVE
  To evaluate whether the Surgical Apgar Score (SAS) can identify patients who are at risk for perioperative adverse events (PAE) following radical prostatectomy for prostate cancer.
  
  
  METHODS
  At a single academic institution, 994 patients undergoing radical prostatectomy between 2010 and 2013 were analyzed retrospectively. The SAS was calculated from anesthesia records, evaluated to predict PAE within a 30-day time period postoperatively; these events were classified according to standardized classification systems.
  
  
  RESULTS
  We observed adverse events in 45.4% (451/994) of patients with a total of 694 events. Overall, 41% (408/994) had low- and 9.9% (98/994) had high-grade events. A lower SAS was identified as an independent predictor of any (p < 0.001) and low-grade adverse events (p = 0.001) for those patients who had undergone open retropubic radical prostatectomy (ORRP). Each 1-point increment resulted in a 24% decrease in the odds of any (95% CI 0.66-0.88) and a 21% decrease in the odds of a low-grade (95% CI 0.69-0.91) event. Adverse events of robot-assisted prostatectomy were not associated with the SAS.
  
  
  CONCLUSIONS
  Lower SAS values indicate patients at risk for adverse events after ORRP. The SAS might serve as one variable for outcome assessment, reflecting the challenge of mutual surgical and anesthesiology procedure management.
authors.affiliation: Department of Urology, Ruhr-University Bochum, Marien Hospital Herne, Herne, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Orberger
authors.forename: Jüri
authors.initials: J
authors.lastname: Palisaar
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
authors.forename: Ludger
authors.initials: L
authors.lastname: Mittelstädt
authors.forename: Petra
authors.initials: P
authors.lastname: Bischoff
authors.forename: Joachim
authors.initials: J
authors.lastname: Noldus
authors.forename: Björn
authors.initials: B
authors.lastname: Löppenberg
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors