Application of the Surgical Apgar Score to Microvascular Head and Neck Reconstruction

The surgical Apgar score (SAS) is a recently devised risk-stratifying metric that relies on 3 intraoperative parameters to predict postoperative complications in surgical patients. The purpose of this study was to validate the SAS externally in a cohort of patients undergoing microvascular head and neck reconstruction with fibular free flaps.

A retrospective cohort study of patients undergoing head and neck microvascular reconstruction with fibular free flaps was completed. The primary predictor variable was the calculated SAS. The primary outcome variable was the presence of medical and surgical complications occurring within 30 days of surgery. Basic demographic information, comorbidity indices, and perioperative parameters were abstracted as covariates. Medical and surgical complications were categorized as minor or major depending on severity level. Univariable and multivariable logistic regression models were used to evaluate associations with 30-day postoperative complications.

In 154 patients, the partial flap failure rate was 3% and there were no complete flap failures. There were 110 patients (71%) who developed at least 1 30-day postoperative complication and 51 (33%) who developed a major complication. The median SAS was 7. The SAS was not significantly associated with the presence of any 30-day postoperative complication (odds ratio [OR] = 1.02; 95% confidence interval [CI], 0.74-1.42; P = .89) or the presence of any major postoperative complication (OR = 0.08; 95% CI, 0.59-1.09; P = .16) in a univariable setting. The SAS did not achieve statistical significance after multivariable adjustment.

Despite validation in numerous other surgical specialties, the SAS might not be useful as a metric for risk stratification among patients undergoing major head and neck reconstruction with fibular free flaps.