Surgical Apgar score as a predictor of outcomes in patients following laparotomy at Mulago National Referral Hospital, Uganda: a prospective cohort study
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
BMC surgery
Abstract
Postoperative complications and mortality following laparotomy have remained high worldwide. Early
postoperative risk stratification is essential to improve outcomes and clinical care. The surgical Apgar score (SAS) is a
simple and objective bedside prediction tool that can guide a surgeon’s postoperative decision making. The objective
of this study was to evaluate the performance of SAS in predicting outcomes in patients undergoing laparotomy at
Mulago hospital.
Method: A prospective observational study was conducted among eligible adult patients undergoing laparotomy
at Mulago hospital and followed up for 4 months. We collected data on the patient’s preoperative and intraoperative
characteristics. Using the data generated, SAS was calculated, and patients were classified into 3 groups namely: low
(8–10), medium (5–7), and high (0–4). Primary outcomes were in-hospital major complications and mortality. Data
was presented as proportions or mean (standard deviation) or median (interquartile range) as appropriate. We used
inferential statistics to determine the association between the SAS and the primary outcomes while the SAS discriminatory
ability was determined from the receiver-operating curve (ROC) analysis.
Results: Of the 151 participants recruited, 103 (68.2%) were male and the mean age was 40.6 ± 15. Overall postoperative
in-hospital major complications and mortality rates were 24.2% and 10.6%, respectively. The participants with
a high SAS category had an18.4 times risk (95% CI, 1.9–177, p = 0.012) of developing major complications, while those
in medium SAS category had 3.9 times risk (95% CI, 1.01–15.26, p = 0.048) of dying. SAS had a fair discriminatory ability
for in-hospital major complications and mortality with the area under the curve of 0.75 and 0.77, respectively. The
sensitivity and specificity of SAS ≤ 6 for major complications were 60.5% and 81.14% respectively, and for death 54.8%
and 81.3%, respectively.
Conclusion: SAS of ≤ 6 is associated with an increased risk of major complications and/or mortality. SAS has a high
specificity with an overall fair discriminatory a
Description
Keywords
Surgical Apgar score, Laparotomy, Major complications
Citation
Onen, B. C., Semulimi, A. W., Bongomin, F., Olum, R., Kurigamba, G., Mbiine, R., & Kituuka, O. (2022). Surgical Apgar score as a predictor of outcomes in patients following laparotomy at Mulago National Referral Hospital, Uganda: a prospective cohort study. BMC surgery, 22(1), 1-12. https://doi.org/10.1186/s12893-022-01883-7