title: New surgical scoring system to predict postoperative mortality.
abstract: OBJECTIVE
  There is still no easy and highly useful method to comprehensively assess both preoperative and intraoperative patient statuses to predict postoperative outcomes. We attempted to develop a new scoring system that would enable a comprehensive assessment of preoperative and intraoperative patient statuses instantly at the end of anesthesia, predicting postoperative mortality.
  
  
  METHODS
  The study included 32,555 patients who underwent surgery under general or regional anesthesia from 2008 to 2012. From the anesthesia records, extracted factors, including patient characteristics and American Society of Anesthesiologists physical status classification (ASA-PS), and three intraoperative indexes (the lowest heart rate, lowest mean arterial pressure, and estimated volume of blood loss) are used to calculate the surgical Apgar score (sAs). The sAs and ASA-PS, and surgical Apgar score combined with American Society of Anesthesiologists physical status classification (SASA), which combines the sAs and ASA-PS into a single adjusted scale, were compared and analyzed with postoperative 30-day mortality.
  
  
  RESULTS
  Increased severity of the sAs, ASA-PS and SASA was correlated with significantly higher mortality. The risk of death was elevated by 3.65 for every 2-point decrease in the sAs, by 6.4 for every 1-point increase in the ASA-PS, and by 9.56 for every 4-point decrease in the SASA. The ROC curves of the sAs and ASA-PS alone also individually demonstrated high validity (AUC = 0.81 for sAs and 0.79 for ASA-PS, P < 0.001). The SASA was even more valid (AUC = 0.87, P < 0.001).
  
  
  CONCLUSIONS
  The sAs and ASA-PS were shown to be extremely useful for predicting 30-day mortality after surgery. An even higher predictive ability was demonstrated by the SASA, which combines these simple and effective scoring systems.
authors.affiliation: Department of Anesthesiology, Tokyo Women's Medical University, Shinjuku, Tokyo, 1628666, Japan.
authors.forename: Maho
authors.initials: M
authors.lastname: Kinoshita
authors.affiliation: Department of Anesthesiology, Tokyo Women's Medical University, Shinjuku, Tokyo, 1628666, Japan. nobutadamorioka@gmail.com.
authors.forename: Nobutada
authors.initials: N
authors.lastname: Morioka
authors.affiliation: Department of Anesthesiology, Tokyo Women's Medical University, Shinjuku, Tokyo, 1628666, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Yabuuchi
authors.affiliation: Department of Anesthesiology, Tokyo Women's Medical University, Shinjuku, Tokyo, 1628666, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Ozaki
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000379:methods*; D000776:Anesthesiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011184:Postoperative Period; D012372:ROC Curve
keywords: American Society of Anesthesiologists physical status classification (ASA-PS); Patient safety; Postoperative mortality; Surgical Apgar score (sAs)