Giugliano Danica N, Morgan Andrew, Palazzo Francesco, Leiby Benjamin E, Evans Nathaniel R, Rosato Ernest L, Berger Adam C
Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania.
J Surg Oncol. 2017 Sep;116(3):359-364. doi: 10.1002/jso.24662. Epub 2017 May 2.
Esophagectomy carries considerable morbidity. Many studies have evaluated factors to predict patients at risk. This study aimed to determine whether the surgical Apgar score (SAS) predicts complications and length of stay (LOS) for patients undergoing esophagectomy.
We evaluated 212 patients undergoing esophagectomy. Postoperative complications were graded using the Clavien-Dindo scale and the SAS was determined. Association of SAS with incidence of complications was evaluated using the Cochran-Armitage trend test between grouped SAS scores (0-2, 3-4, 5-6, 7-8, 9-10) and each of the outcomes. Correlation of SAS with LOS was evaluated using competing risks proportional hazards regression.
The average patient age was 63.5 years (range 31-86), and the average blood loss was 284 mL (range 50-4000). The median LOS was 10 days. There was a significant association between SAS and grade 2 or higher (P = 0.0002) and grade 3 or higher (P < 0.0001) complications. The perioperative mortality rate was 5.2% (n = 11) with lower SAS being associated with greater mortality. LOS was also associated with SAS (P < 0.0001).
We demonstrate that SAS is a significant predictor of complications and LOS for patients undergoing esophagectomy. SAS should be used to identify lower risk patients to prioritize use of critical care beds and hospital resources.
食管切除术具有较高的发病率。许多研究评估了预测高危患者的因素。本研究旨在确定手术阿普加评分（SAS）是否能预测接受食管切除术患者的并发症和住院时间（LOS）。
我们评估了212例接受食管切除术的患者。术后并发症采用Clavien-Dindo分级标准进行分级，并确定SAS评分。使用 Cochr an-Armitage趋势检验评估分组后的SAS评分（0 - 2、3 - 4、5 - 6、7 - 8、9 - 10）与各结局之间SAS与并发症发生率的相关性。使用竞争风险比例风险回归评估SAS与LOS的相关性。
患者平均年龄为63.5岁（范围31 - 86岁），平均失血量为284 mL（范围50 - 4000 mL）。中位住院时间为10天。SAS与2级或更高等级（P = 0.0002）以及3级或更高等级（P < 0.0001）并发症之间存在显著关联。围手术期死亡率为5.2%（n = 11），较低的SAS与较高的死亡率相关。LOS也与SAS相关（P < 0.0001）。
我们证明，SAS是接受食管切除术患者并发症和LOS的重要预测指标。SAS应用于识别低风险患者，以便优先使用重症监护床位和医院资源。
