Surgical Apgar Outcome Score: Perioperative Risk Assessment for Radical Cystectomy
Surgical Apgar Outcome Score: Perioperative Risk Assessment for Radical Cystectomy
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DOI：
10.1016/j.juro.2008.10.165
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发表时间：
2009-03-01
影响因子：
6.6
通讯作者：
Hu, Jim C.
中科院分区：
文献类型：
--
作者：
Prasad, Sandip M.;Ferreria, Marcos;Hu, Jim C.
目的：目前，根治性膀胱切除术缺乏客观的围手术期风险评估指标。使用类似于新生儿阿普加评估的简单10分量表，我们评估了根治性膀胱切除术后立即计算的手术结果评分是否可以预测主要并发症和死亡率。材料和方法：我们选择了2005-2007年间在我们机构连续进行的155例根治性膀胱切除术。收集了45个术前和术中变量的数据。我们使用国家外科质量改进计划建立的框架来评估手术后30天内的主要并发症。我们使用了先前在普通外科和血管外科人群中验证的10分评分系统，包括估计的失血量、最低心率和最低平均动脉压。结果：共有40名(26%)接受根治性膀胱切除术的患者在手术后30天内发生了主要并发症。并发症发生率随手术Apgar评分的增加而逐渐减少，低评分与高评分的患者发生并发症的可能性较大(OR 6.9，95%CI 1.9~24.2)。冠状动脉疾病、美国麻醉师学会级别、术中输血量、静脉输液量和女性也与主要并发症有关(p<；0.05)。结论：根治性膀胱切除术患者的手术阿氏评分可预测主要术后并发症和死亡。这一简单而客观的术后指标可以用来决定护理的强度。需要进行前瞻性研究，以确定基于该评分系统的治疗决定是否能改善根治性膀胱切除术的结果。
Purpose: Currently objective perioperative risk assessment metrics are lacking for radical cystectomy. Using a simple 10-point scale similar to neonatal Apgar assessment we evaluated whether a surgical outcome score calculated immediately after radical cystectomy would predict major complications and mortality.Materials and Methods: We identified 155 consecutive radical cystectomies performed between 2005 and 2007 at our institution. Data were collected on 45 preoperative and intraoperative variables. We used a framework established by the National Surgical Quality Improvement Program to evaluate major complications within 30 days of surgery. We used a 10-point scoring system that had been previously validated in general and vascular surgery populations, comprising estimated blood loss, lowest heart rate and lowest mean arterial pressure.Results: A total of 40 (26%) patients undergoing radical cystectomy experienced a major complication within 30 days of the operation. There was a progressive decrease in complications with increasing surgical Apgar score, in that patients with a low vs a high Apgar score were more likely to experience complications (OR 6.9, 95% CI 1.9-24.2). Coronary artery disease, American Society of Anesthesiologists class, intraoperative blood transfusion, volume of intravenous fluid administered and female gender were also associated with major complications (p < 0.05).Conclusions: In patients undergoing radical cystectomy the surgical Apgar score predicts major postoperative complications and death. This simple and objective postoperative metric may be used to dictate the intensity of care. Prospective studies are needed to determine whether treatment decisions based on this scoring system improve radical cystectomy outcomes.