Surgical Apgar score as a predictor of outcomes in patients undergoing Laparotomy at Mulago Hospital: prospective cohort study.

Abstract

Background: Postoperative complications and mortality following laparotomy has 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 risk prediction tool that can be used immediately for decision making or guide postoperative care. 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 in eligible adult patients undergoing laparotomy at Mulago National referral hospital during a 4-month period were recruited. Data were collected on the patient’s preoperative and intraoperative characteristics. SAS was calculated and patients categorized into 3 SAS categories. Outcomes were in-hospital major complications and mortality. The association between the SAS and outcomes was tested using binary logistic regression, crude and adjusted relative risk were determined, and the SAS discriminatory ability was determined from the receiver-operating curve (ROC) analysis. Results: Of the 180 patients requiring laparotomy, 151 were studied with male to female ratio of 2:1. The mean age was 40.61 (±15). Overall postoperative in-hospital major complications and mortality rates were 24.2% and 10.6% respectively. Low SAS was associated with high likelihood of developing major complications and dying. Compared with low-risk SAS (8-10), the adjusted relative risk for major complication was 18.4 (95% CI, 1.9-177, P=0.012), while for mortality when compared with medium risk SAS (5-7), the adjusted relative risk for mortality for those in the high-risk group was 3.9(95% CI, 1.01-15.26, p=0.048). SAS had a fair discriminatory ability for postoperative in-hospital major complication and mortality with area under curve of 0.75 and 0.77 respectively. The sensitivity and specificity of SAS ≤6 for major complication was 60.5% and 81.14% respectively, for death was 54.8% and 81.3% specificity respectively. Conclusions: Low SAS is associated with increased risk of major complications and/or mortality. SAS has a high specificity with an overall fair discriminatory ability for predicting those at high or low risk of developing in-hospital major complications and/or death following laparotomy.