The intraoperative Surgical Apgar Score predicts postdischarge complications after colon and rectal resection

Background

We previously developed an intraoperative 10-point Surgical Apgar Score—based on blood loss, lowest heart rate, and lowest mean arterial pressure—to predict major complications after colorectal resection. However, because complications often arise after uncomplicated hospitalizations, we sought to evaluate whether this intraoperative metric would predict postdischarge complications after colectomy.

Methods

We linked our institution's National Surgical Quality Improvement Program database with an Anesthesia Intraoperative Management System for all colorectal resections over 4 years. Using Chi-square trend tests and logistic regression, we evaluated the Surgical Apgar Score's prediction for major postoperative complications before and after discharge.

Results

Among 795 colectomies, there were 230 (29%) major complications within 30 days; 45 (20%) after uncomplicated discharges. Surgical Apgar Scores predicted both inpatient complications and late postdischarge complications (both P < .0001). Late complications occurred from 0 to 27 (median, 11) days after discharge; the most common were surgical site infections (42%), sepsis (24%), and venous thromboembolism (16%). In pairwise comparisons against average-scoring patients (Surgical Apgar Scores, 7–8), the relative risk of postdischarge complications trended lower, to 0.6 (95% confidence interval [CI], 0.2–1.7) for those with the best scores (9–10); and were significantly higher, at 2.6 (95% CI, 1.4–4.9) for scores 5–6, and 4.5 (95% CI, 1.8–11.0) for scores 0–4.

Conclusion

The intraoperative Surgical Apgar Score remained a useful metric for predicting postcolectomy complications arising after uncomplicated discharges. Even late complications may thus be related to intraoperative condition and events. Surgeons could use this intraoperative metric to target low-scoring patients for intensive postdischarge surveillance and mitigation of postdischarge complications after colectomy.