Evaluation of surgical Apgar score in predicting post-laparotomy complications


  • Nimish J. Shah Department of Surgery, Medical College and SSG Hospital, Vadodara, Gujarat, India
  • Ram Singh Choudhary Department of Surgery, Medical College and SSG Hospital, Vadodara, Gujarat, India
  • Shish Ram Jangir Department of Surgery, Medical College and SSG Hospital, Vadodara, Gujarat, India
  • Divyang Patel Department of Surgery, Medical College and SSG Hospital, Vadodara, Gujarat, India




Surgical Apgar score, Post laparotomy complications, Heart rate, Mean arterial pressure, Expected blood loss


Background: Surgical Apgar score is a simple, objective and economical ten point post-operative prognostic scoring system based on three readily recorded intra operative variables. Aim is to evaluate the applicability and accuracy of the surgical Apgar score in predicting post-operative complications and objectives are to identify patients at risk of developing post-operative complications based on intra-operative data, to study the incidence of post-operative complications and morbidity and mortality in patients undergoing elective and emergency laparotomy.

Methods: This was a prospective analytical study carried out at SSG Hospital from November 2018 to October 2019 and achieved sample size was 160 patients. Surgical Apgar score was calculated at the end of the operation from these three parameters: heart rate, mean arterial pressure and expected blood loss.

Results: Out of 160 patients, 77 patients were in group 0-5 and complications occurred in 45 patients (58.4%), 54 patients in group 6-7 in which 18 patients (33.3%) suffered a complication and 29 patients in 8-10 surgical Apgar score, rate of complications was 17.3% in category 8-10 Apgar score.

Conclusions: Complications are more in low Apgar score patients compared to high Apgar score and in emergency cases compared to elective surgeries, would require more intensive monitoring in the postoperative period.

Author Biography

Ram Singh Choudhary, Department of Surgery, Medical College and SSG Hospital, Vadodara, Gujarat, India



Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32(4):260-7.

Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ. An Apgar score for surgery. J Am Coll Surg. 2007;204(2):201-8.

Dullo M, Ogenda SWO, Nyaim EO. Surgical Apgar score predicts post laparatomy complications. Annals Afr Surg. 2013;10(2):24-9.

Regenbogen SE, Ehrenfeld JM, Lipsitz SR, Greenberg CC, Hunter MM, Gawande AA. Utility of the surgical Apgar score, validation in 4119 patients. Arch Surg. 2009;144(1):30-6.

Wuerz TH, Regenbogen SE, Ehrenfeld JM, Malchau H, Rubash H, Gawande AA, et al. The surgical Apgar score in hip and knee arthroplasty. Clin Orthop Relat Res. 2011;469:1119-26.

Haynes AB, Regenbogen SE, Weiser TG, Lipsitz SR, Dziekan G, Berry WR, Gawande AA. Surgical outcome measurement for a global patient population. Surg. 2011;149(4):519-24.

Thorn CC, Chan M, Sinha N, Harrison RA. Utility of the surgical Apgar score in a district general hospital. World J Surg. 2012;36:1066-73.

Assifi MM. Lindenmeyer J, Leiby BE, Grunwald Z, Rosato EL, Kennedy EP, et al. Surgical Apgar score predicts perioperative morbidity in patients undergoing pancreatico-duodenectomy at a high-volume centre. J Gastrointest Surg. 2012;16;275-81.

Ziewacz JE, Davis MC, Lau D, El-Sayed AM, Regenbogen SE, Sullivan SE, et al. Validation of the surgical Apgar score in a neurosurgical patient population. J Neurosurg. 2013;36:1066-73.

Sobol JB, Gershengorn HB, Wunsch H, Li G. The surgical Apgar score is strongly associated with intensive care unit admission after high risk intra-abdominal surgery. Anesth Analg. 2013;117(2):438-46.

Kotera A. The surgical Apgar score can help predict postoperative complications in femoral neck fracture patients: a 6 year retrospective cohort study. JA Clin Rep. 2018;4:67.

Santoshsingh SR, Sathyakrishna BR. Surgical Apgar score-a simple prognostic tool in surgery. Int J Sci Stud. 2016;4(4):1-5.






Original Research Articles