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Validation in 4119 Patients

Scott E. Regenbogen, MD, MPH; Jesse M. Ehrenfeld, MD; Stuart R. Lipsitz, ScD; Caprice C. Greenberg, MD, MPH; Matthew M. Hutter, MD, MPH; Atul A. Gawande, MD, MPH

Arch Surg. 2009;144(1):30-36.

Objectives  To confirm the utility of a 10-point Surgical Apgar Score to rate surgical outcomes in a large cohort of patients.

Design  Using electronic intraoperative records, we calculated Surgical Apgar Scores during a period of 2 years (July 1, 2003, through June 30, 2005).

Setting  Major academic medical center.

Patients  Systematic sample of 4119 general and vascular surgery patients enrolled in the National Surgical Quality Improvement Program surgical outcomes database at a major academic medical center.

Main Outcome Measures  Incidence of major postoperative complications and/or death within 30 days of surgery.

Results  Of 1441 patients with scores of 9 to 10, 72 (5.0%) developed major complications within 30 days, including 2 deaths (0.1%). By comparison, among 128 patients with scores of 4 or less, 72 developed major complications (56.3%; relative risk, 11.3; 95% confidence interval, 8.6-14.8; P < .001), of whom 25 died (19.5%; relative risk, 140.7; 95% confidence interval, 33.7-587.4; P < .001). The 3-variable score achieves C statistics of 0.73 for major complications and 0.81 for deaths.

Conclusions  The Surgical Apgar Score provides a simple, immediate, objective means of measuring and communicating patient outcomes in surgery, using data routinely available in any setting. The score can be effective in identifying patients at higher- and lower-than-average likelihood of major complications and/or death after surgery and may be useful for evaluating interventions to prevent poor outcomes.

Author Affiliations: Department of Health Policy and Management, Harvard School of Public Health (Drs Regenbogen, Greenberg, and Gawande), Departments of Surgery (Drs Regenbogen and Hutter) and Anesthesia and Critical Care (Dr Ehrenfeld), Massachusetts General Hospital, and Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital (Drs Lipsitz, Greenberg, and Gawande), Boston, Massachusetts.

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