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· DOS Abstracts
Low Surgical Apgar Score is associated with
postoperative complications in lower extremity
amputations in dysvascular patients.
Christian Wied, Nicolai Bang Foss, Morten Tange Kristensen, Gitte Holm, Thomas
Kallemose, Anders Troelsen
Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre;
Department of Anesthesiology and Intensive Care, Copenhagen University Hospital
Hvidovre; Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C),
Department of Physical Therapy, Copenhagen University Hospital Hvidovre; Department
of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Department
of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Department of
Orthopaedic Surgery, Copenhagen University Hospital Hvidovre
Background:
There is an increasing number of high-risk, elderly and severely comorbid
patients, scheduled for dysvascular lower extremity amputations (LEA). An easy to apply
risk stratification tool would be of great value for individualizing postoperative monitor-
ing and care.
Purpose / Aim of Study:
To assess whether the Surgical Apgar Score (SAS, 0-10
points) is a prognostic tool capable of identifying the most vulnerable patients with ma-
jor complications (including death) following LEA surgery. The SAS score is based on
intraoperative heart rate, blood pressure and blood loss.
Materials and Methods:
An observational cohort study of 170 dysvascular patients
undergoing transtibial (TTA, n=70) or transfemoral (TFA, n=100) amputations from
2013- 2015. Data on perioperative morbidity and mortality was collected retrospec-
tively.
Findings / Results:
When the calculated scores were divided into four groups (SAS:
0-4, 5-6, 7-8, 9-10) a logistic regression model showed a significant linear associa-
tion between decreasing SAS and postoperative complications (all patients: OR = 2.00
[1.33-3.03], p = 0.001). This effect was pronounced for TFA (OR = 2.61 [1.52-4.47],
p < 0.001). The AUC from the models were estimated to (all patients = 0.648 [0.562-
0.733], p = 0.001), (TFA = 0.710 [0.606- 0.813], p<0.001), and (TTA = 0.528
[0.383-0.672], p = 0.472) pointing at a moderate discriminatory power of the SAS in
predicting postoperative complications in TFA patients.
Conclusions:
It seems warranted that the SAS provides the medical staff with informa-
tion regarding the potential development of complications following TFA. The scoring
system could prove useful in guiding preventive strategies such as optimizing intraopera-
tive blood pressure or heart rate. The SAS showed no discriminatory power in the TTA
sub- group, most likely due to an overall better condition of the patients.
No conflicts of interest reported
113.