The Application Of Surgical Apgar Score In The Assessment Of Perioperative Morbidity And Mortality In Patients With Pancreatic Cancer

Purpose:Pancreatic cancer is the fourth leading cause of cancer related death in the USA in2010, and surgical resection remains the only potentially curative treatment. Despite advances in surgical technique, however, the5-year survival for patients with pancreatic cancer still remains low. Several large studies from high-volume centers have reported that postoperative morbidity rates from40%to43%. It has been proved that evaluation of risk factors causing adverse outcomes can make a great benefit. There are already lots of clinical scoring systems, of which some complex scoring algorithms such as the Acute Physiology and Chronic Health Evaluation (APACHE) score and the Physiologic and Operative Severity Score for the Enumeration of Mortality (POSSUM) have been confirmed to predict patient complications in the perioperative setting effectively. However, these tools are complicated and require complex calculations that need numerous perioperative variables not readily available at the bedside. Furthermore, some of those results are difficult to understand. Gawande et al. proposed a10-point scoring algorithm named surgical Apgar score (SAS), which uses three intraoperative parameters:estimated blood loss (EBL), heart rate (HR) and mean arterial pressure (MAP). In his study containing767patients undergoing general or vascular operations, the result turned out that SAS score was significantly associated with major complications or death within30days. Our study was designed to determine if the SAS could accurately predict perioperative morbidity and mortality in patients with pancreatic cancer and there has no previously reported articles to date.Material and methods:Clinical data was retrospectively reviewed in222patients who received pancreatic surgery and were diagnosed with pancreatic cancer through postoperative pathology from January,2007to December,2012.Results:There were about81.8%patients whose SAS<5had post-operational complications and the percentage of which was44%in patients whose SAS>6(P=0.001). In addition,9of22(40.9%) had pancreatic fistula, which was significantly higher than that of patients whose SAS≥6(P=0.004). The SAS of those who had been dead after surgery were all less than5. The incidence of post-operational complications, pancreatic fistula, surgical time and estimated blood loss in non-PD group were significantly higher than that of the PD group. However, there were no differences in both heart rate and mean arterial pressure between the two groups. In addition, SAS well predicted post-operational complications and pancreatic fistula in non-PD group but not PD group. Furthermore, SAS could predict hospital stays and hospitalization costs.Conclusion:Surgical apgar score is not only a simple, rapid scoring system, it can effectively predict the risk of perioperative morbidity and pancreatic fistula in non-PD group, but it is not sure for PD group and needs further research. SAS will help the allocation of medical resources and make the better treatment for those patients with greater risk of complications or death.