Utility of surgical APGAR score in predicting post-operative morbidity and mortality in patients undergoing laparotomy – A prospective study

ABSTRACT

Background: The best model to determine the postoperative complications must be simple and easily applicable to the majority of surgical patients. The complications and their incidence should be precisely defined and estimated. The model should also have a low threshold to identify them. The ASA classification was initially intended as a means to stratify a patient’s systemic illness but not post-operative risk. Although the ASA classification has proved to be a predictive pre-operative risk factor in mortality models, its subjective nature and inconsistent scoring between providers make it less than ideal for performing evidence-based post-operative risk calculation. Aim of the study The aim of the study was to determine the applicability of the Surgical Apgar Score in post-operative risk stratification for morbidity and mortality during the 30 days postlaparotomy. Materials and methods: In this study, 152 in-patient Visiting Government Stanley Medical College General Hospital from March 2017 to April 2018 had been studied. Patients undergone laparotomy at Department of General Surgery, Government Stanley Medical College were managed by a tier of doctors from anesthetic technicians, medical officer interns, medical officers, postgraduates in general surgery and anesthesiology and their consultants. Interns and postgraduates in general surgery provided the pre and postoperative care and participate in general surgical procedures whenever indicated. Anesthesiologists apart from providing anesthesia during surgery extended their care in the intensive care unit. Parimala, G. Venkatesh, P. Vijayaraghavan. Utility of surgical APGAR score in predicting post-operative morbidity and mortality in patients undergoing laparotomy – A prospective study. IAIM, 2019; 6(6) 67-74. Page 68 Results: 132 patients were operated as an emergency and only 20 patients were operated selectively. 86.8% of the surgeries were emergency laparotomies and only 13.2% of the surgeries were elective. This showed our efficient functioning and round the clock services of our emergency theatres. The most common causes in descending order include penetrating injury, intestinal obstruction, peritonitis, perforated duodenal ulcer, blunt injury abdomen, intra-abdominal abscess, hydatid cyst, obstructed hernia, mesenteric ischemia, cholecystitis. A significantly higher complication was noted among female patients at 63.2% compared to male patients at 33.3%. 43.9% of the postoperative complications occurred in emergency setting whereas only 20% of the complications occurred in the elective setting. When the complications were compared with the duration of surgery, those surgeries that lasted more than 120 minutes had a higher complication rate of 68.6% whereas surgeries with a shorter duration only had a complication rate of 26.7%. Conclusion: Surgical Apgar Score is very effective in identifying high-risk patients who are capable of developing significant complications following laparotomy within the first 30 postoperative days. This identification of high-risk patients helps us in the judicious use of healthcare resources towards the proper monitoring and follow up of these patients.