Surgery
Volume 148, Issue 3 , Pages 559-566 , September 2010

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

Presented in poster format the 2009 Annual Meeting of the American Society of Colon and Rectal Surgeons in Hollywood, Florida, and as an oral presentation at the 2009 Annual Spring Meeting of the New England Society of Colon and Rectal Surgeons in Manchester, New Hampshire.

  • Scott E. Regenbogen, MD, MPH

      Affiliations

    • Department of Surgery, Massachusetts General Hospital, Boston, MA
    • Department of Health Policy and Management, Harvard School of Public Health, Boston, MA
    • Corresponding Author InformationReprint requests: Scott E. Regenbogen, MD, MPH, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, GRB-425, Boston, MA 02114.
    • ,
  • Liliana Bordeianou, MD

      Affiliations

    • Department of Surgery, Massachusetts General Hospital, Boston, MA
    • ,
  • Matthew M. Hutter, MD, MPH

      Affiliations

    • Department of Surgery, Massachusetts General Hospital, Boston, MA
    • ,
  • Atul A. Gawande, MD, MPH

      Affiliations

    • Department of Health Policy and Management, Harvard School of Public Health, Boston, MA
    • Department of Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA

,Accepted 18 January 2010.

References 

  1. Hutter MM, Rowell KS, Devaney LA, et al. Identification of surgical complications and deaths: an assessment of the traditional surgical morbidity and mortality conference compared with the American College of Surgeons–National Surgical Quality Improvement Program. J Am Coll Surg. 2006;203:618–624
  2. Vincent C, Moorthy K, Sarker SK, et al. Systems approaches to surgical quality and safety: from concept to measurement. Ann Surg. 2004;239:475–482
  3. Schilling PL, Dimick JB, Birkmeyer JD. Prioritizing quality improvement in general surgery. J Am Coll Surg. 2008;207:698–704
  4. Medress Z, Fleshner PR. Can we predict unplanned hospital readmission after colectomy for ulcerative colitis and indeterminate colitis?. Am Surg. 2007;73:998–1001
  5. Hyman N, Manchester TL, Osler T, et al. Anastomotic leaks after intestinal anastomosis: it's later than you think. Ann Surg. 2007;245:254–258
  6. Marang-van de Mheen PJ, van Duijn-Bakker N, Kievit J. Adverse outcomes after discharge: occurrence, treatment and determinants. Qual Saf Health Care. 2008;17:47–52
  7. Kiran RP, Delaney CP, Senagore AJ, et al. Outcomes and prediction of hospital readmission after intestinal surgery. J Am Coll Surg. 2004;198:877–883
  8. Azimuddin K, Rosen L, Reed JF, et al. Readmissions after colorectal surgery cannot be predicted. Dis Colon Rectum. 2001;44:942–946
  9. Kariv Y, Wang W, Senagore AJ, et al. Multivariable analysis of factors associated with hospital readmission after intestinal surgery. Am J Surg. 2006;191:364–371
  10. Delaney CP, Fazio VW, Senagore AJ, et al. ‘Fast track’ postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg. 2001;88:1533–1538
  11. Hartley MN, Sagar PM. The surgeon's ‘gut feeling’ as a predictor of post-operative outcome. Ann R Coll Surg Engl. 1994;76(6 Suppl):277–278
  12. Gawande AA, Kwaan MR, Regenbogen SE, et al. An Apgar score for surgery. J Am Coll Surg. 2007;204:201–208
  13. Regenbogen SE, Ehrenfeld JM, Lipsitz SR, et al. Utility of the Surgical Apgar Score: validation in 4119 patients. Arch Surg. 2009;144:30–36
  14. Regenbogen SE, Lancaster RT, Lipsitz SR, et al. Does the Surgical Apgar Score measure intraoperative performance?. Ann Surg. 2008;248:320–328
  15. Fink AS, Campbell DA, Mentzer RM, et al. The National Surgical Quality Improvement Program in non-Veterans Administration hospitals: initial demonstration of feasibility. Ann Surg. 2002;236:344–353
  16. Khuri SF, Daley J, Henderson W, et al. The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg. 1995;180:519–531
  17. Semi-annual report. Washington, DC: ACS NSQIP Advisory Committee; 2006;
  18. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213
  19. Reich DL, Wood RK, Mattar R, et al. Arterial blood pressure and heart rate discrepancies between handwritten and computerized anesthesia records. Anesth Analg. 2000;91:612–616
  20. Armitage P. Test for linear trends in proportions and frequencies. Biometrics. 1955;11:375–386
  21. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36
  22. Welch HG, Larson EH, Hart LG, Rosenblatt RA. Readmission after surgery in Washington State rural hospitals. Am J Public Health. 1992;82:407–411
  23. Munoz E, Goldstein J, Lory MH, et al. The DRG hospital payment system, surgical readmissions and cost containment. Am Surg. 1990;56:683–687
  24. Courtney ED, Ankrett S, McCollum PT. 28-Day emergency surgical re-admission rates as a clinical indicator of performance. Ann R Coll Surg Engl. 2003;85:75–78
  25. Thomas JW, Holloway JJ. Investigating early readmission as an indicator for quality of care studies. Med Care. 1991;29:377–394
  26. Stewart S, Pearson S, Luke CG, Horowitz JD. Effects of home-based intervention on unplanned readmissions and out-of-hospital deaths. J Am Geriatr Soc. 1998;46:174–180
  27. Townsend J, Piper M, Frank AO, et al. Reduction in hospital readmission stay of elderly patients by a community based hospital discharge scheme: a randomised controlled trial. BMJ. 1988;297:544–547
  28. Stewart S, Marley JE, Horowitz JD. Effects of a multidisciplinary, home-based intervention on unplanned readmissions and survival among patients with chronic congestive heart failure: a randomised controlled study. Lancet. 1999;354:1077–1083
  29. Gawande AA, Thomas EJ, Zinner MJ, Brennan TA. The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery. 1999;126:66–75
  30. Rogers SO, Gawande AA, Kwaan M, et al. Analysis of surgical errors in closed malpractice claims at 4 liability insurers. Surgery. 2006;140:25–33
  31. Charlson ME, MacKenzie CR, Gold JP, et al. The preoperative and intraoperative hemodynamic predictors of postoperative myocardial infarction or ischemia in patients undergoing noncardiac surgery. Ann Surg. 1989;210:637–648
  32. Reich DL, Bodian CA, Krol M, et al. Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infarction after coronary artery bypass surgery. Anesth Analg. 1999;89:814–822
  33. Barone JE, Bull MB, Cussatti EH, et al. Perioperative myocardial infarction in low-risk patients undergoing noncardiac surgery is associated with intraoperative hypotension. J Intensive Care Med. 2002;17:250–255
  34. Hartmann B, Junger A, Rohrig R, et al. Intra-operative tachycardia and peri-operative outcome. Langenbeck Arch Surg. 2003;388:255–260
  35. Wolters U, Wolf T, Stutzer H, Schroder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77:217–222
  36. Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg. 2005;100:4–10
  37. O'Brien DP. Predictors and outcome of readmission after laparoscopic intestinal surgery. World J Surg. 2007;31:2138–2143
  38. Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983;148:839–843
  39. Cohen ME, Bilimoria KY, Ko CY, Hall BL. Development of an American College of Surgeons National Surgery Quality Improvement Program: morbidity and mortality risk calculator for colorectal surgery. J Am Coll Surg. 2009;208:1009–1016

 S.E.R. was supported by Kirschstein National Research Service Award T32-HS000020 from the Agency for Healthcare Research and Quality.

PII: S0039-6060(10)00031-0

doi: 10.1016/j.surg.2010.01.015

Surgery
Volume 148, Issue 3 , Pages 559-566 , September 2010

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