The Clinical Application Of Modified Surgical Apgar Score In The Assessment Of Postoperative Risk Of Pancreatic Cancer

Background:Pancreatic cancer is the fourth leading cause of cancer related death in the USA, though its incidence range 11th in all cancers. In China, the incidence of pancreatic cancer range 6th and 8th in male and female respectively. Surgical resection remains the only potentially curative treatment. Despite advances in surgical technique, however, the 5-year survival for patients of pancreatic cancer still remains low. The postoperative mortality declines, but it is reported that postoperative morbidity rates remains high about 30-60%. 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, but these tools are complicated and require complex calculations that need numerous perioperative variables not readily available at the bedside. Gawande et. proposed a 10-point scoring algorithm named surgical Apgar score, which uses three intraoperative parameters:estimated blood loss(EBL), heart rate(HR) and mean arterial pressure(MAP). The result in his study turned out that surgical Apgar score was significantly associated with major complications or death within 30 days in patients undergoing general or vascular operations. Our study found that the surgical Apgar score could predict perioperative morbidity, but the predictive ability still can be improved.Purpose:Constructing a modified surgical Apgar score to improve the predictive ability and clinical application value in the assessment of postoperative risk of pancreatic cancer.Material and methods:Clinical data was retrospectively reviewed in 160 patients who received pancreatic surgery and were diagnosed with pancreatic cancer through postoperative pathology from January,2007 to September,2015. The data was analyzed before and after the modification of surgical Apgar score.Results:There were total 160 patients,92 males and 68 females. The age ranges from 30 to 82.5 deaths(3.1%) within 30days after pancreatic surgery, and 80 patients(50%) occurred postoperative complications, in detail 30 occurred pneumonia,28 occurred pancreatic fistula,27 occurred pleural effusion and so on. The t test showed there was no significant relationship between surgical Apgar score and death(p= 0.242). The surgical Apgar score was significantly related with postoperative complications(p= 0.013). When analyzed with single parameter of surgical Apgar score, significant relationship was found between EBL or MAP and postoperative complications(p< 0.002 and p= 0.017, respectively), while there was no significant relationship between HR and postoperative complications(p= 0.979). Besides, operation time(OT) was found significantly related with postoperative complications(p< 0.001). Thus we proposed a modified surgical Apgar score, and the sensitivity, specificity and accuracy was improved largely when compared with the original surgical Apgar score, from 66.3% to 81.3%, from 50.0% to 73.8%, and from 58.1% to 77.5%, respectively. Furthermore, the modified surgical Apgar score could predict hospital stays and hospitalization cost(p< 0.001).Conclusion:Surgical Apgar score is a simple, rapid scoring system, the modified surgical Apgar score can effectively predict the risk of perioperative morbidity. The modification to surgical Apgar score enhanced the predictive ability for postoperative morbidity.