Surgical Apgar score is strongly associated with postoperative ICU admission

Area of Science:

• Anesthesiology
• Surgical Outcomes
• Critical Care Medicine

Background:

• Immediate postoperative intensive care unit (ICU) admission improves survival in high-risk surgery patients.
• Lack of reliable criteria limits ICU admission to <15% of eligible patients.
• The surgical Apgar score (SAS) shows potential for predicting outcomes after intra-abdominal surgery.

Purpose of the Study:

• To investigate the association between the surgical Apgar score (SAS) and immediate postoperative ICU transfer across all types of surgeries.
• To evaluate the SAS as a predictive tool for ICU admission.
• To identify factors influencing ICU admission decisions.

Main Methods:

• Retrospective analysis of 13,139 patients undergoing operative anesthesia.
• Data collection included patient demographics, American Society of Anesthesiologists (ASA) class, surgery type, and SAS.
• Statistical analysis to determine the relationship between SAS, ASA class, and ICU admission.

Main Results:

• Only 7.8% of patients were immediately transferred to the ICU.
• Lower SAS scores (0-6) were significantly associated with increased ICU admission (ORs 5.2, 2.26, 1.73 for SAS 0-2, 3-4, 5-6 respectively; P < 0.001).
• Higher ASA class and lower SAS were linked to higher ICU admission rates.

Conclusions:

• The surgical Apgar score (SAS) is a valuable, intraoperatively calculated tool for predicting postoperative ICU transfer.
• SAS can aid clinical decision-making for immediate ICU admission after various surgical procedures.
• Lower SAS scores are strong indicators for potential ICU needs.