A STUDY OF EFFICACY OF SURGICAL APGAR SCORE IN PREDICTING MORBIDITY AND MORTALITY IN PATIENTS UNDERGOING MAJOR ELECTIVE SURGERIES

Abstract

AIMS AND OBJECTIVE: - A STUDY OF EFFICACY OF SURGICAL APGAR SCORE IN PREDICTING MORBIDITY AND MORTALITY IN PATIENTS
UNDERGOING MAJOR ELECTIVE SURGERIES STUDY SETTING: All the patients undergoing major abdominal surgeries like open Cholecystectomy, CBD exploration, gastrectomy, colectomy , abdominal perineal resections and including thyroid surgeries and modified radical mastectomy will be included in study ESICMC KALABURGI. TYPE OF STUDY: - A hospital based prospective study. MATERIALS AND METHODS: - This study included 100 subjects whose age ranged from 18 years to 82 years with mean age 46.15 ± 15.65 years. The study's duration was between (2023-2024).The study will involve all individuals undergoing major surgery. All clinical data, including history, clinical symptoms, and diagnosis, as well as laboratory and radiological examinations, will be obtained and documented. Intraoperative results, including operative diagnosis and procedure nature, will be collected. SAS [Surgical Apgar Score] is determined using the three parameters which are estimated blood loss [EBL], lowest mean arterial pressure [MAP], and lowest heart
rate [HR]. RESULTS: - Complications occurred in 14 (14%) of 100 subjects in our current study, including surgical site infection (7%), chest infection (1%), anastomotic leak (1%), hypotension (2%), myocardial infarction (1%), POD 5-Ischemic stroke with Aphasia(1%), post-operative biliary leak (1%), and primary haemorrhage with hypotension with hypovolemic shock (1%). In our current investigation, there is a significant difference in the distribution of Total Protein with a mean value of 7.04±0.71 and a p- value of 0.043MW*, Estimated Blood Loss with a mean value of 227.88±103.94 and a p- value of 0.001MW*, according to the Mann Whitney U test. Similarly, with a mean value of 73.22± 8.73 and a p-value of 0.0234MW*, the lowest heart rate across morbidity was found. In our current study, a significant difference in mean Lowest Mean Arterial Pressure across morbidity was found, with a mean value of 64.54±8.47 and a p value of 0.0298t* using a two sample t test. In our recent study, we identified a significant variation in the distribution of surgical APGAR[Appearance, Pulse, Grimace, Activity and Respiration] score over morbidity: APGAR SCORE ranged from 1 (1%), 3 (3%), 10 (10%), 20 (20%), 31 (31%), and 27 (27%), with a p-value of 0.005MC*.At cut-off 6, the surgical APGAR score has an area under the ROC curve
(AU-ROC) of 0.715, predicting morbidity with 70.93% sensitivity and 64.29% specificity. The APGAR score after surgery is substantially linked with morbidity (p- value = 0.0024), according to logistic regression. Morbidity increases by 0.4753 for every unit increase in surgical APGAR score. As a result, the surgical APGAR score has a high discriminant power in predicting morbidity. CONCLUSION: - The surgical Apgar score system aids in the prediction of morbidity and death following surgery. A lower surgical Apgar score is related with an increased risk of morbidity or fatality. This score allows surgeons to identify patients who are most likely to have serious problems or die. By allowing for earlier detection of possible problems, it allows for improved supervision of patients at higher risk.