Utility of the surgical apgar score: Validation in 4119 patients

Objectives: To confirm the utility of a 10-point Surgical Apgar Score to rate surgical outcomes in a large cohort of patients. Design: Using electronic intraoperative records, we calculated Surgical Apgar Scores during a period of 2 years (July 1, 2003, through June 30, 2005). Setting: Major academic medical center. Patients: Systematic sample of 4119 general and vascular surgery patients enrolled in the National Surgical Quality Improvement Program surgical outcomes database at a major academic medical center. Main Outcome Measures: Incidence of major post-operative complications and/or death within 30 days of surgery. Results: Of 1441 patients with scores of 9 to 10, 72 (5.0%) developed major complications within 30 days, including 2 deaths (0.1%). By comparison, among 128 patients with scores of 4 or less, 72 developed major complications (56.3%; relative risk, 11.3; 95% confidence interval, 8.6-14.8; P<.001), of whom 25 died (19.5%; relative risk, 140.7; 95% confidence interval, 33.7-587.4; P<.001). The 3-variable score achieves C statistics of 0.73 for major complications and 0.81 for deaths. Conclusions: The Surgical Apgar Score provides a simple, immediate, objective means of measuring and communicating patient outcomes in surgery, using data routinely available in any setting. The score can be effective in identifying patients at higher- and lower-than-average likelihood of major complications and/or death after surgery and may be useful for evaluating interventions to prevent poor outcomes.