Centro Hospitalar Universitário do Porto, Porto, Portugal.
Anesthesiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Rev Esp Anestesiol Reanim (Engl Ed). 2023 Apr;70(4):198-208. doi: 10.1016/j.redare.2022.02.007. Epub 2023 Feb 24.
The surgical Apgar score (SAS) is a perioperative risk evaluation score, which considers intraoperative minimum heart rate, minimum mean arterial pressure and estimated blood loss. Although validated in multiple surgical fields, SAS remains quite controversial in the orthopedic one. The main purpose of this study was to investigate if SAS relates with the occurrence of complications during the first 30-days after proximal femoral fracture surgery.
Retrospective study including all consecutive patients submitted to proximal femoral fracture surgery between January and July 2019. Patients with no information about SAS were excluded. Patients were divided in two groups, based on the occurrence of complications during the first 30 post-operative days and their SAS calculated. Receiver operating characteristic (ROC) curves were used to assess SAS power as a predictive model of complications.
Forty-two percent (n = 76) of the 181 patients included in the study developed complications during the first 30 postoperative days. Eight patients (4,4%) died during that period. The patient's mean age was 79 years and 30,9% (n = 56) were men. Heart failure, pacemaker use, chronic kidney disease, chronic obstructive pulmonary disease and dementia were significantly associated with post-operative morbidity. There was no significant correlation between SAS and the occurrence of complications during the first 30 postoperative days. The AUC of SAS as a predictive model for postoperative complications after proximal femoral fracture surgery was 0,522, being insufficient to be considered an accepted model of prediction.
Based on this study, we conclude that SAS is not predictive of the development of complications in the first 30 post-operative days in patients submitted to proximal femoral fracture surgery. However, other clinical factors have been identified as associated with postoperative morbidity. In the future, prospective-based studies with higher samples may better clarify the role of SAS in this context.
手术 Apgar 评分（SAS）是一种围手术期风险评估评分，它考虑了术中最低心率、最低平均动脉压和估计失血量。尽管在多个外科领域得到了验证，但 SAS 在骨科领域仍存在很大争议。本研究的主要目的是研究 SAS 是否与股骨近端骨折手术后 30 天内并发症的发生有关。
回顾性研究纳入 2019 年 1 月至 7 月期间接受股骨近端骨折手术的所有连续患者。排除无 SAS 信息的患者。根据术后 30 天内是否发生并发症将患者分为两组，并计算其 SAS。使用受试者工作特征（ROC）曲线评估 SAS 作为并发症预测模型的效能。
在纳入的 181 例患者中，42%（n=76）在术后 30 天内发生并发症。在此期间，有 8 例（4.4%）患者死亡。患者的平均年龄为 79 岁，30.9%（n=56）为男性。心力衰竭、起搏器使用、慢性肾脏病、慢性阻塞性肺疾病和痴呆与术后发病率显著相关。SAS 与术后 30 天内并发症的发生无显著相关性。SAS 作为股骨近端骨折手术后术后并发症预测模型的 AUC 为 0.522，不足以被认为是一种可接受的预测模型。
基于本研究，我们得出结论，SAS 不能预测股骨近端骨折手术后 30 天内并发症的发生。然而，已经确定了其他与术后发病率相关的临床因素。未来，基于前瞻性的大样本研究可能会更好地阐明 SAS 在这方面的作用。
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