Acil cerrahide ameliyat sonrasý komplikasyonlarýn öngörülmesinde modifiye cerrahi APGAR skorunun kullanýmý: Gözlemsel geriye dönük çalýþma

AMAÇ: Gawande ve ark.nýn 2007 yýlýnda tanýmladýðý Cerrahi Apgar (SAS), skorlama sisteminin ameliyat sonrasý komplikasyon insidansýný ve morta-liteyi tahmin etmede oldukça etkili olduðu gösterilmiþtir. Bu çalýþmada, acil cerrahide ameliyat sonrasý komplikasyon insidansýný ve mortaliteyi tahmin etmek için yeni, modifiye edilmiþ bir SAS tanýmlamayý amaçladýk. Ayrýca, SAS skorunun üç intraoperatif parametresine ek olarak operasyonun süresinden oluþan bu modifiye edilmiþ skorlama sisteminin etkinliðini de ölçmek istedik.
GEREÇ VE YÖNTEM: Bu geriye dönük gözlemsel çalýþmaya acil cerrahi uygulanan 579 hasta dahil edildi. Operasyon sonunda hastalarýn muayene-sinden elde edilen verilerden SAS hesaplandý ve SAS hesaplamasýnda kullanýlan verilere operasyon süresi eklenerek modifiye SAS (mSAS) hesaplandý (Cerrahi süre >8 sa; -4 puan; 7.01–8 sa; -3 puan; 5.01–7 sa; -2 puan; 3.01–5 sa; -1 puan; 0–3 sa; 0 puan eklendi).
BULGULAR: mSAS ile toplam komplikasyon sayýsý arasýnda istatistiksel olarak anlamlý bir iliþki vardý (ameliyat süresi arttýkça komplikasyon sayýsý arttý) (r=0.360; p=0.001). SAS ve mSAS’ýn uyum düzeyleri %98.4 idi ve istatistiksel olarak anlamlý bulundu (ICC: 0.984; p=0.001; p<0.01). TARTIÞMA: Operasyon süresinin, büyük operasyonlarda SAS risk skorunun basit, objektif ve pratik bir göstergesi olarak dahil edilmesi gerektiðini öneriyoruz. mSAS, ameliyat sonrasý mortalite ve komplikasyonlarýn baðýmsýz bir prediktörüdür. Elektronik týbbi kayýt sistemlerinin ve ameliyat öncesi týbbi verilerin etkin kullanýmý ile mSAS, prognozu tahmin etmek için kolay ve yeni bir puanlama sistemi olarak kullanýlabilir.

Use of a modified surgical APGAR score for prediction of postoperative complications in emergency surgery: An observational retrospective study

BACKGROUND: The surgical Apgar score (SAS) was defined by Gawande et al. in 2007. It has been shown that this scoring system was highly effective for predicting the incidence of post-operative complications and mortality. In this study, we aimed to define a new, modified SAS (mSAS) for predicting the incidence of post-operative complications and mortality in emergency surgery. We also wanted to quantify the effectiveness of this modified scoring system, comprising of the duration of the operation in addition to the three intraoperative parameters of the SAS score.
METHODS: Five hundred and seventy-nine patients who underwent emergency surgery were enrolled in this retrospective obser-vational study. At the end of the operation, the SAS was calculated from the data obtained from the examination of the patients and the mSAS was calculated by adding the duration of the operation to data used in the calculation of the SAS (Surgical duration >8 h; –4 points; 7.01–8 h; –3 points; 5.01–7 h; –2 points; 3.01–5 h; –1 points; 0–3 h; 0 points added).
RESULTS: There was a statistically significant relationship between the mSAS and the total number of complications (as operative time [OT] increased, the number of complications increased) (r=0.360; p=0.001). The compliance levels of the SAS and mSAS were 98.4% and they have been found as statistically significant (ICC: 0.984; p=0.001; p<0.01).
CONCLUSION: We suggest that the OT should be included as a simple, objective and practical indication of the SAS risk score in major operations. The mSAS was an independent predictor of post-operative mortality and complications. With the widespread use of electronic medical record systems and the effective use of pre-operative medical data, the mSAS can be used as an easy and new scoring system to predict prognosis.