Jakub Kenig1, Kinga Mastalerz2, Katarzyna Lukasiewicz3, Maria Mitus-Kenig4, Urszula Skorus5. 1. Department of General, Oncologic and Geriatric Surgery, Jagiellonian Univeristy Medical College, 35-37 Pradnicka Str., 31-202, Krakow, Poland. Electronic address: jkenig@cm-uj.krakow.pl. 2. Department of General, Oncologic and Geriatric Surgery, Jagiellonian Univeristy Medical College, 35-37 Pradnicka Str., 31-202, Krakow, Poland. Electronic address: kinga.mastalerz@yahoo.fr. 3. Department of General, Oncologic and Geriatric Surgery, Jagiellonian Univeristy Medical College, 35-37 Pradnicka Str., 31-202, Krakow, Poland. Electronic address: kat.lukasiewicz@gmail.com. 4. Department of Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, 4 Montelupich Str., 31-155, Krakow, Poland. Electronic address: maria.mitus-kenig@uj.edu.pl. 5. Department of General, Oncologic and Geriatric Surgery, Jagiellonian Univeristy Medical College, 35-37 Pradnicka Str., 31-202, Krakow, Poland. Electronic address: urszula.skorus@gmail.com.
Abstract
The Surgical Apgar Score (SAS) is a simple and rapid scoring system predicting postoperative mortality and morbidity. However, it remains unknown whether it might be useful in fit and frail older patients undergoing abdominal emergency surgery. METHODS: Consecutive patients ≥65 years, needing emergency abdominal surgery were enrolled in this prospective study. Additionally to the SAS, the G8 screening score was used to determine the frailty status. The logistic regression analysis was conducted investigating the association between the scores and 30-day postoperative outcomes. RESULTS: The study sample comprised 315 older patients (165 female, 150 male) with a median age of 77 (range 65-100) years old. The prevalence of frailty was 60.3%. The most frequent surgical indications were acute cholecystitis, followed by ileus, complicated diverticulitis, ulcer perforation, complication of gastric cancer and other causes. The decreasing SAS was significantly associated with the increasing likelihood of both 30-day postoperative major complications (p < 0.01) and death (p < 0.01) both in fit and frail older patients. Multivariate analyses have identified the G8, frailty screening test, and the SAS score as independent factors that predict postoperative adverse events. The model combining both scores increased the discriminatory ability for 30-day postoperative major morbidity and mortality. CONCLUSION: The SAS confirmed to be a simple and powerful predictor of 30-day postoperative morbidity and mortality both in fit and frail older patients undergoing emergency abdominal surgery. The department allocation algorithm based of the combination of the G8 and the SAS may be considered as an option to improve the outcomes of older patients undergoing abdominal emergency surgery.
The Surgical Apgar Score (SAS) is a simple and rapid scoring system predicting postoperative mortality and morbidity. However, it remains unknown whether it might be useful in fit and frail older patients undergoing abdominal emergency surgery. METHODS: Consecutive patients ≥65 years, needing emergency abdominal surgery were enrolled in this prospective study. Additionally to the SAS, the G8 screening score was used to determine the frailty status. The logistic regression analysis was conducted investigating the association between the scores and 30-day postoperative outcomes. RESULTS: The study sample comprised 315 older patients (165 female, 150 male) with a median age of 77 (range 65-100) years old. The prevalence of frailty was 60.3%. The most frequent surgical indications were acute cholecystitis, followed by ileus, complicated diverticulitis, ulcer perforation, complication of gastric cancer and other causes. The decreasing SAS was significantly associated with the increasing likelihood of both 30-day postoperative major complications (p < 0.01) and death (p < 0.01) both in fit and frail older patients. Multivariate analyses have identified the G8, frailty screening test, and the SAS score as independent factors that predict postoperative adverse events. The model combining both scores increased the discriminatory ability for 30-day postoperative major morbidity and mortality. CONCLUSION: The SAS confirmed to be a simple and powerful predictor of 30-day postoperative morbidity and mortality both in fit and frail older patients undergoing emergency abdominal surgery. The department allocation algorithm based of the combination of the G8 and the SAS may be considered as an option to improve the outcomes of older patients undergoing abdominal emergency surgery.
Authors: Alexander Reinisch; Martin Reichert; Christian Charles Ondo Meva; Winfried Padberg; Frank Ulrich; Juliane Liese Journal: Eur J Trauma Emerg Surg Date: 2022-02-02 Impact factor: 2.374