S. Amodeo1, A. Masi1,2, A. Pinna1,2,3, I. Hatzaras1, E. Newman1,2, S. M. Cohen1, R. S. Berman1, G. H. Ballantyne1,2, H. L. Pachter1, M. Melis1,2 1New York University School Of Medicine,Department Of Surgery,New York, NY, USA 2New York Harbor Healthcare System VAMC,Department Of Surgery,New York, NY, USA 3University Of Sassari,Department Of General Surgery,Sassari, , Italy
Introduction: The Surgical Apgar Score (SAS) is a 10-point score calculated on three intra-operative parameters (lowest heart rate, lowest mean arterial pressure, estimated blood loss), which has been demonstrated to be a reliable predictor of postoperative morbidity and mortality in several types of surgery. We aimed to investigate whether SAS could also predict length of post-operative hospital stay (LOS) in patients undergoing general surgical procedures.
Methods: We retrospectively evaluated demographics, medical history, type of surgery, and postoperative data for patients undergoing general surgery between October 2006 and September 2011. We categorized our study population into 4 groups according to their SAS: ≤4, 5-6, 7-8, 9-10. The end-point of our study was the length of postoperative hospital stay. We used Pearson’s chi-square or ANOVA, as appropriate, to evaluate differences across SAS groups.
Results: Two thousand one hundred twenty-five patients underwent general surgery during the evaluated period. We excluded 711 patients who underwent outpatient surgery, and included in our analysis the 1414 patients who were admitted post-operatively to the hospital. There were 29 patients in the group SAS ≤ 4, 212 in SAS 5-6, 594 in SAS 7-8, 579 in SAS 9-10. No significant differences in age, sex, race, history of smoking or alcohol abuse among SAS groups were detected. Patients with lower SAS had a worse preoperative functional status (p<0.001) and worse American Society of Anesthesiologists score (p<0.001) than patients with a higher SAS. A low SAS was associated with a higher incidence of certain preoperative conditions (acute renal failure, ascites, history of myocardial infarction, congestive heart failure, severe COPD, dyspnea, history of dialysis: p<0.001; diabetes: p=0.001; history of angina, previous percutaneous coronary intervention, previous cardiac surgery: p<0.05). Most patients with low SAS underwent major or extensive procedures (89.7% and 75.5% for score ≤4 and 5-6, respectively), while high SAS patients mostly underwent minor or intermediate surgery (68.6% for score 9-10). LOS ranged from 0 to 193 days, with a median of 6 days (mean: 11.9 ± 18.8 days). LOS was 29.6 ± 26.5 for score ≤ 4, 24.2 ± 30.8 for score 5-6, 12.1 ± 16.0 for score 7-8, and 6.4 ± 10.9 for score 9-10 (p<0.001).
Conclusion: In our retrospective analysis SAS correlated with post-operative LOS after general surgery. Moving forward, this information may be used to focus hospital resources (such as social workers and rehabilitation medicine) specifically on patients with low SAS, who are at higher risk for prolonged post-operative length of stay.