Hino Haruaki, Hagihira Satoshi, Maru Natsumi, Utsumi Takahiro, Matsui Hiroshi, Taniguchi Yohei, Saito Tomohito, Murakawa Tomohiro
Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan.
Department of Anesthesiology, Kansai Medical University, Osaka, Japan.
Eur J Cardiothorac Surg. 2023 Apr 3;63(4). doi: 10.1093/ejcts/ezad036.
The surgical Apgar score, calculated using 3 intraoperative variables (blood loss, lowest mean arterial pressure and lowest heart rate), is associated with mortality in cancer surgery. The original score has less applicability in lung cancer surgery; therefore, we innovated the modified pulmonary surgical Apgar score with additional intraoperative oxygen saturation representing pulmonary parenchymal damage and cardiopulmonary dynamics.
We retrospectively analysed the data of 691 patients who underwent surgery for primary lung cancer between 2015 and 2019 at a single institute. We analysed the utility of the pulmonary surgical Apgar score compared with the original surgical Apgar score.
Postoperative complications were observed in 57 (8.2%) and 7 (1.0%) of the 691 patients who were stratified as grade ≥III and V, respectively, according to the Clavien-Dindo classification. We compared the fitness of the score in predicting postoperative complications; the calculated c-index (0.622) was slightly higher than the original c-index (0.604; P = 0.398). Patients were categorized into 3 groups based on their scores as follows: 0-6 points (n = 59), 7-9 points (n = 420) and 10-12 points (n = 212). Univariable and multivariable analyses demonstrated that a lower score was an independent negative risk factor for postoperative complications (odds ratio 3.53; P = 0.02). Patients with lower scores had a considerably poor 5-year overall survival (64.6%) (P = 0.07).
The pulmonary surgical Apgar score predicts postoperative complications and long-term survival in patients with lung cancer undergoing surgery and may be utilized for postoperative management.
手术阿普加评分采用3个术中变量（失血量、最低平均动脉压和最低心率）计算得出，与癌症手术的死亡率相关。原始评分在肺癌手术中的适用性较低；因此，我们创新了改良的肺手术阿普加评分，增加了术中氧饱和度以反映肺实质损伤和心肺动力学。
我们回顾性分析了2015年至2019年在一家机构接受原发性肺癌手术的691例患者的数据。我们分析了肺手术阿普加评分与原始手术阿普加评分相比的效用。
根据Clavien-Dindo分类，691例患者中分别有57例（8.2%）和7例（1.0%）术后出现≥III级和V级并发症。我们比较了该评分预测术后并发症的适用性；计算得出的c指数（0.622）略高于原始c指数（0.604；P = 0.398）。根据评分将患者分为3组如下：0 - 6分（n = 59）、7 - 9分（n = 420）和10 - 12分（n = 212）。单因素和多因素分析表明，较低的评分是术后并发症的独立负性危险因素（比值比3.53；P = 0.02）。评分较低的患者5年总生存率相当低（64.6%）（P = 0.07）。
肺手术阿普加评分可预测肺癌手术患者的术后并发症和长期生存情况，可用于术后管理。
