Improved Re-estimation of Perioperative Cardiac Risk Using the Surgical Apgar Score: A Retrospective Cohort Study.

Autor:	Daza JF; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada., Bartoszko J; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.; Department of Anesthesia and Pain Management, Toronto General Hospital-University Health Network, Toronto, ON, Canada., Van Klei W; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.; Department of Anesthesia and Pain Management, Toronto General Hospital-University Health Network, Toronto, ON, Canada.; Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands., Ladha KS; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.; Department of Anesthesia and Pain Management, Toronto General Hospital-University Health Network, Toronto, ON, Canada.; Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada., McCluskey SA; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.; Department of Anesthesia and Pain Management, Toronto General Hospital-University Health Network, Toronto, ON, Canada., Wijeysundera DN; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.; Department of Anesthesia and Pain Management, Toronto General Hospital-University Health Network, Toronto, ON, Canada.; Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2023 Jul 01; Vol. 278 (1), pp. 65-71. Date of Electronic Publication: 2022 Jul 08.
DOI:	10.1097/SLA.0000000000005509
Abstrakt:	Objective: To assess whether the Surgical Apgar Score (SAS) improves re-estimation of perioperative cardiac risk. Background: The SAS is a novel risk index that integrates three relevant and easily measurable intraoperative parameters (blood loss, heart rate, mean arterial pressure) to predict outcomes. The incremental prognostic value of the SAS when used in combination with standard preoperative risk indices is unclear. Methods: We conducted a retrospective cohort study of adults (18 years and older) who underwent elective noncardiac surgery at a quaternary care hospital in Canada (2009-2014). The primary outcome was postoperative acute myocardial injury. The SAS (range 0-10) was calculated based on intraoperative estimated blood loss, lowest mean arterial pressure, and lowest heart rate documented in electronic medical records. Incremental prognostic value of the SAS when combined with the Revised Cardiac Risk Index was assessed based on discrimination (c-statistic), reclassification (integrated discrimination improvement, net reclassification index), and clinical utility (decision curve analysis). Results: The cohort included 16,835 patients, of whom 607 (3.6%) patients had acute postoperative myocardial injury. Addition of the SAS to the Revised Cardiac Risk Index improved risk estimation based on the integrated discrimination improvement [2.0%; 95% confidence interval (CI): 1.5%-2.4%], continuous net reclassification index (54%; 95% CI: 46%-62%), and c-index, which increased from 0.68 (95% CI: 0.65-0.70) to 0.75 (95% CI: 0.73-0.77). On decision curve analysis, addition of the SAS to the Revised Cardiac Risk Index resulted in a higher net benefit at all decision thresholds. Conclusions: When combined with a validated preoperative risk index, the SAS improved the accuracy of cardiac risk assessment for noncardiac surgery. Further research is needed to delineate how intraoperative data can better guide postoperative decision-making. Competing Interests: The authors report no conflicts of interest. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu