The Value Of Modified Surgical Apgar Score In Predicting Postoperative Complications Of Hilar Cholangiocarcinoma

Objective:To explore the value of modified surgical Apgar score(mSAS)in predicting postoperative complications of hilar cholangiocarcinoma(HC).Methods:Clinical data of 180 patients with hilar cholangiocarcinoma who underwent radical resection in Shengjing Hospital of China Medical University from April 2013 to September 2019 were analyzed retrospectively.They were divided into a complication group(n=120)and a non-complication group(n=60).Compare clinical data of two groups of patients,including sex,age,CEA,CA19-9,Bismuth-Corlette type,preoperative jaundice and albumin levels,SAS,mSAS,surgical procedure et al.t test is used for comparison of positive skewness distribution,and nonparametric tests are used for comparison of skewed measurement data.?~2 test is used for comparison of counted data,and nonparametric tests are used for comparison of ranked data.Multivariate logistic regression was used to analyze the risk factors of postoperative complications of HC.The predictive power of mSAS and SAS for postoperative complications of HC were compared by receiver operating curve(ROC).Results:180 patients in 120 cases(66.7%)had complications postoperatively.mSAS comparison between patients with complications and no complications was statistically difference(?~2=59.683,P<0.001).The complication rate was 41.8%in the high score group((29)6)and 96.3%in the low score group(?6).Single complication analysis showed that there were statistically significant differences in mSAS between patients with bacteremia,pulmonary infection,abdominal infection,incision complications,intraperitoneal hemorrhage and liver insufficiency and those without corresponding complications(?~2=15.934,48.293,45.997,5.244,10.911,16.153,all P<0.05),while there were no statistically significant differences in mSAS between patients with bile leakage and those without corresponding complications(?~2=0.822,P>0.05).Multivariate analysis showed that mSAS(OR=0.029,95%CI:0.008?0.112,P<0.001),surgical procedure(OR=2.343,95%CI:1.129?4.864,P=0.022),and preoperative jaundice(OR=2.504,95%CI:1.384?4.533,P=0.002)may have effects on postoperative complications of HC.The area under curve(AUC)for mSAS and SAS predicting complications after HC was0.826(95%CI:0.763?0.879)and 0.770(95%CI:0.702?0.830),respectively.The cut-off value of mSAS is 6.5,the sensitivity is 96.3%,the specificity is 58.2%,and the accuracy is 75.6%.Conclusion:Modified surgical Apgar score is an effective method for predicting postoperative complications of hilar cholangiocarcinoma,and it has better prediction effect than surgical Apgar score.Modified surgical Apgar score?6,surgical procedure,and preoperative jaundice were independent risk factors for postoperative complications of hilar cholangiocarcinoma.