Efficacy of the surgical Apgar score in predicting post-operative morbidity and mortality in patients undergoing laparotomy


  • Vandhana Rajgopal Department of General Surgery, M S Ramaiah Medical College, Bengaluru, Karnataka, India
  • Shrikant V. Kulkarni Department of General Surgery, M S Ramaiah Medical College, Bengaluru, Karnataka, India




Surgical Apgar score, Laparotomy, Predicting complications, Predicting mortality


Background: A surgical score that predicts the risk of developing complications and mortality will help surgeons to be alert and take appropriate pro-active steps. The objective of this study was to evaluate the efficacy of the Surgical Apgar Score in predicting post-operative morbidity and mortality in patients undergoing major laparotomy surgeries.

Methods: 100 patients undergoing major surgery were enrolled. 45 of these were emergency surgeries for peptic ulcer obstructions, bowel obstructions, pelvic abscess, mesenteric infarction and pancreatic necrosis. 55 cases were elective surgeries for cancers of the stomach, colon and rectum, pancreas, liver and ovaries. The Surgical Apgar Score (SAS) was calculated intra-operatively based on estimated blood loss, lowest mean arterial pressure and lowest heart rate. Post-operative complications and mortality were recorded.

Results: Of the 23% of patients with a low SAS (< 4), major complications were noted in 41%, and 30-day mortality was seen in 26%. On the other hand, of patients with a high SAS of (9-10), only 11% suffered 30-day morbidities, and 4% had 30-day mortality. Patients with a SAS of < 2 had a relative risk of 13.6 for development of complications, and a relative risk of 239 for 30-day mortality.

Conclusions: The surgical Apgar scoring system helps predict post-operative morbidity and mortality. A lower surgical Apgar score is associated with a higher chance of developing morbidity or mortality. This score allows surgeons to identify patients at highest risk of major complications or death. By enabling earlier identification of potential problems it affords the opportunity to provide increased surveillance for patients at higher risk. 


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