HOLLYWOOD, FLA. — A 10-point scale based on three intraoperative hemodynamic factors accurately predicts which patients undergoing colorectal resection are likely to experience complications after discharge, according to a study of nearly 800 patients.
The traditional Apgar score is a convenient 10-point scale to assess the status of a newborn shortly after birth. Scores 3 and below are regarded as critically low, 4–6 are fairly low, and 7–10 are normal.
A “surgical Apgar” score can calculate a patient's condition following general or vascular surgery and grade the chances of major complications or death. Among the advantages of using a surgical Apgar score are immediate feedback, no cost, and little effort, Dr. Scott E. Regenbogen said. A patient's score is computed in the operating room using estimated blood loss, lowest mean arterial pressure, and lowest heart rate. (See box.)
“We are looking for opportunities to improve outcomes,” Dr. Regenbogen said in an interview at his poster during the annual meeting of the American Society of Colon and Rectal Surgeons.
He and his associates assessed outcomes after 795 colorectal resections over 4 years at Massachusetts General Hospital in Boston. The likelihood of complications after discharge quadrupled among patients with an operating room score between 0 and 4 (relative risk, 4.5), compared with a reference group that had scores of 7 or 8. “So information in the OR still gives us valuable information on how they do even after they leave the hospital,” said Dr. Regenbogen, of Massachusetts General Hospital.
The likelihood of complications after discharge also was higher for patients who scored 5 or 6 (RR, 2.6) but lower for those who scored the highest, a 9 or 10 (RR, 0.6).
There were 49 patients in the 0–4 score group, 186 patients in the 5–6 group, 406 patients in the reference 7–8 group, and 154 in the 9–10 group. The complication rates were 24% for the lowest scoring group, 14% for the 5–6 score group, 5% for the reference group, and 3% among those who scored the highest in the operating room.
The researchers used data from the American College of Surgeons National Surgical Quality Improvement Program database at Massachusetts General Hospital and the institution's Anesthesia Information Management System.
Previous studies validated the score's significant associations with complications in the immediate postoperative period and for other procedures, he said.
For example, a study of 4,119 general and vascular procedures at Mass General and Brigham and Women's Hospital, also in Boston, showed that the score significantly predicts in-hospital postoperative complications (Ann. Surg. 2008;248:320–8). A patient who scored a 7 or 8 in the operating room had no significant change, compared with preoperative risk variables (likelihood ratio, 1.05). In contrast, a score of 0–4 nearly tripled the odds of a major complication within 30 days (LR, 2.80). Again, the best outcomes were associated with a score of 9 or 10 (LR, 0.52).
Dr. Regenbogen had no conflicts of interest to declare.
Source ELSEVIER GLOBAL MEDICAL NEWS