The Surgical Apgar Score Is Not Associated With Post-operative Outcomes in Patients Undergoing Bariatric Surgery

Lin M Riccio, MD, Beth E Turrentine, PhD, RN, Amir K Abdel Malek, Bruce D Schirmer, MD, Peter T Hallowell, MD. University of Virginia

Introduction: The Surgical Apgar Score was developed and validated across a wide breadth of surgical subspecialties. It is a simple, useful tool to identify patients at high risk of developing post-operative complications by using readily available intraoperative data. Similar to the Apgar score used in obstetrics, the Surgical Apgar Score is a point scoring system, and lower scores are associated with worse outcomes. To date, there has been no study that has examined the utility of the Surgical Apgar score in patients undergoing bariatric surgery. We hypothesize that lower Surgical Apgar Scores are associated with higher rates of post-operative complications in patients undergoing bariatric surgery.

Methods: We performed an analysis of the National Surgical Quality Improvement Program data for 800 consecutive patients undergoing bariatric surgery at a single academic medical center from 2009 to 2013. Patients were divided into two cohorts, those who were identified in NSQIP as having a post-operative complication, and those without complications. Using intraoperative measurements available on the anesthesia database, Surgical Apgar Scores were calculated for each patient. Surgical Apgar scores were then compared between cohorts. Statistical analysis included Student's t-test for comparing means and Fishers exact test for categorical variables.

Results: Of the 800 patients identified in NSQIP, 121 (15.1%) patients developed post-operative complications. There were two deaths (0.25%). Patient characteristics, types of bariatric operations, and outcomes are summarized in Table 1. Surgical Apgar Scores were similar between the two group (7.06 in patients with complications versus 7.27 in those without, p=0.12).

Conclusion: Surgical Apgar Scores are not lower in patients with complications after bariatric surgery.

Table 1. Patient Characteristics, Procedures, Outcomes