Background:
Esophagectomy is a procedure that carries considerable morbidity. Many studies have evaluated factors to predict patients at risk and improve clinical outcomes. The aim of this study was to determine whether the SAS predicts complications, length of stay, and anastomotic leak for patients undergoing esophagectomy at a high-volume institution.https://jdc.jefferson.edu/surgeryposters/1002/thumbnail.jp

Berger, MD, Adam C.

Evans III, M.D., Nathaniel R.

Giugliano, MD, Danica

Leiby, PhD, Benjamin E

Morgan, Andrew

Palazzo, MD, Francesco

Rosato, MD, Ernest L

Background:
Esophagectomy is a procedure that carries considerable morbidity. Many studies have evaluated factors to predict patients at risk and improve clinical outcomes. The aim of this study was to determine whether the SAS predicts complications, length of stay, and anastomotic leak for patients undergoing esophagectomy at a high-volume institution.http://jdc.jefferson.edu/surgeryposters/1002/thumbnail.jp

Name not available

Surgical Apgar Score (SAS) Predicts Perioperative Morbidity and Length of Stay in Patients Undergoing Esophagectomy at a High-Volume Center

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsDepartment of Surgery Posters Department of Surgery5-27-2016Surgical Apgar Score (SAS) Predicts PerioperativeMorbidity and Length of Stay in PatientsUndergoing Esophagectomy at a High-VolumeCenterDanica Giugliano, MDDepartment of Surgery, Thomas Jefferson University, danica.giugliano@jefferson.eduAndrew MorganDepartment of Surgery, Thomas Jefferson UniversityFrancesco Palazzo, MDDepartment of Surgery, Thomas Jefferson University, francesco.palazzo@jefferson.eduNathaniel R. Evans III, M.D.Department of Surgery, Thomas Jefferson University, Nathaniel.Evans@jefferson.eduErnest L Rosato, MDDepartment of Surgery, Thomas Jefferson University, Ernest.Rosato@jefferson.eduSee next page for additional authorsFollow this and additional works at: http://jdc.jefferson.edu/surgerypostersPart of the Surgery CommonsThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inDepartment of Surgery Posters by an authorized administrator of the Jefferson Digital Commons. For more information, please contact:JeffersonDigitalCommons@jefferson.edu.Recommended CitationGiugliano, MD, Danica; Morgan, Andrew; Palazzo, MD, Francesco; Evans III, M.D., Nathaniel R.; Rosato, MD, Ernest L; Berger, MD,Adam C.; and Leiby, PhD, Benjamin E, "Surgical Apgar Score (SAS) Predicts Perioperative Morbidity and Length of Stay in PatientsUndergoing Esophagectomy at a High-Volume Center" (2016). Department of Surgery Posters. 3.http://jdc.jefferson.edu/surgeryposters/3AuthorsDanica Giugliano, MD; Andrew Morgan; Francesco Palazzo, MD; Nathaniel R. Evans III, M.D.; Ernest LRosato, MD; Adam C. Berger, MD; and Benjamin E Leiby, PhDThis book is available at Jefferson Digital Commons: http://jdc.jefferson.edu/surgeryposters/3    Table 4. Median length of hospital stay  (from nonparametric cumulative incidence estimate) Results Table 1. Patient characteristics, procedures, and 30-day outcomes Conclusions •  We demonstrate that SAS is a significant predictor of complications and length of stay for patients undergoing esophagectomy. •  The SAS should be used to identify patients at lower risk in order to prioritize use of postoperative critical care beds and hospital resources.   References Surgical Apgar Score (SAS) Predicts Perioperative Morbidity and Length of Stay in Patients Undergoing Esophagectomy at a High-Volume Center Danica Giugliano MD1, Andrew Morgan1, Francesco Palazzo MD1, Nathaniel Evans MD1, Ernest L. Rosato MD1, Adam C. Berger MD 1, Benjamin Leiby PhD 2,  Department of Surgery 1 and Biostatistics and Clinical Pharmacology 2, Thomas Jefferson University, Philadelphia, PA 19107 Background  Esophagectomy is a procedure that carries considerable morbidity. Many studies have evaluated factors to predict patients at risk and improve clinical outcomes. The aim of this study was to determine whether the SAS predicts complications, length of stay, and anastomotic leak for patients undergoing esophagectomy at a high-volume institution.   Methods  We evaluated 212 patients undergoing successful esophagectomy between January 2005 and April 2014. Postoperative complications were graded using a modification of the Clavien-Dindo scale1, and the SAS (range 0-10), modified from Gawande et al. 2, was determined. Association of SAS with incidence of anastomotic leak and complications was evaluated using the Cochran Armitage trend test between grouped SAS scores (0-2, 3-4, 5-6, 7-8, 9-10) and each of the outcomes. Correlation of Apgar score with length of stay was evaluated using competing risks proportional hazards regression.  •  The average patient age was 63.5 years (range 31-86), and the average blood loss was 300 mL (range 50-4000). The median length of stay was 18.5 days (Table 4). •  There was a significant association between SAS and Grade 2 or higher (p= 0.0002) and Grade 3 or higher (p<0.0001) complications, but not with anastomotic leak (p=0.29) (Table 3). •  The perioperative mortality rate was 5.2% (n=11) with lower SAS being associated with greater mortality (Table 3).  •  Length of stay was also associated with SAS (p<0.0001) with higher scores being associated with shorter length of stay (Table 4).  •  Minimally-invasive esophagectomy was associated with a lower rate of anastomotic leak (p=0.0047) and of Grade 3 or higher complication (p=0.0071), independent of SAS. •  Adjustment for age did not change the significance of the associations. [1] Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-213. [2] Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ. An apgar score for surgery. J Am Coll Surg. 2007;204(2):201-208.  Table 3. Incidence of anastomotic leak and complications by surgical Apgar score category  Surgical Apgar Score n n (%) with Anastomotic Leak n (%) with Grade 2 or Higher Complication n (%) with Grade 3 or Higher Complication n (%) with perioperative death 0-2 5 2 (40) 5 (100) 3 (60) 1 (20) 3-4 23 6 (26) 17 (74) 15 (65) 4 (17) 5-6 81 12 (15) 81 (56) 27 (33) 5 (6) 7-8 96 17 (18) 43 (45) 22 (23) 1 (1) 9-10 7 1 (14) 1 (14) 0 (0) 0 (0) Trend test p-value 0.29 0.0002 <0.0001 0.0006 Surgical Apgar Score Median LOS (days) ALL 18.5 0-2 20 3-4 16 5-6 10 7-8 9 9-10 8 Trend test p-value <0.0001 Table 2. The 10-point surgical Apgar score modified for esophagectomy 0 points 1 point 2 points 3 points 4 points EBL (mL) >400 201-400 100-200 <100 -- Lowest MAP (mmHg) <40 40-54 55-69 ≥70 --- Lowest HR (beats/min) >85 76-85 66-75 56-65 ≤55 n (range or %) Preoperative variables: No. of included patients 212 Age (mean (years)) 63.5 (31-86) Gender (male) 175 (82.5) ASA (mean) 2.86 (2-4) Intraoperative variables: Lowest heart rate  (mean (beats/min)) 58.7 (20-105) Lowest mean arterial pressure (mean (mmHg)) 54.6 (30-85) Estimated blood loss  (mean (mL)) 300.0 (50-4000) Operative duration  (mean (min)) 445.4 (156-738) Operative Procedures: Open 84 (39.6) Minimally Invasive Esophagectomy 128 (60.4) Postoperative outcomes: No complications 83 (39.2) Minor complications (Clavien 1,2) 62 (29.2) Major complications (Clavien 3,4) 56 (26.4) Deaths (Clavien 5) 11 (5.2) Background/Methods ®

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Surgical Apgar Score (SAS) Predicts Perioperative Morbidity and Length of Stay in Patients Undergoing Esophagectomy at a High-Volume Center

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