Surgical Apgar Score can Accurately Predict Post-Operative Complication Following Emergency Laparotomy

Abstract

Abstract Background The Surgical Apgar Score (SAS) describes a feasible and objective tool for predicting surgical outcomes. However, the accuracy and applicability of the score has not been widely tested in majority of low resource settings. Objective To determine the accuracy of Surgical Apgar Score in predicting post-operative complications among patients undergoing emergency laparotomy at Muhimbili National Hospital. Methods A prospective cohort study was conducted for a period of 12 months; SAS and CCI outcomes were recorded and analyzed according to the risk level and degree of severity. Spearman correlation and simple linear regression were employed to establish the relationship between SAS and CCI, the Accuracy of SAS was evaluated by determining its discriminatory capacity on ROC, data normality was tested by Shapiro-Wilk statistic 0.929 (p < 0.001) .Analysis was done using IBM –SPSS. Results Among 111 patients who underwent emergency laparotomy, 71 (64%) were male, the mean age was 49 (± 17). The mean SAS was 4.86 (± 1.29) and mean CCI 44.46 (± 25.77), patients in high-risk group SAS (0–4) were more likely to develop severe and life threatening complications with mean CCI 53.3 (47. 2- 63.4, 95% CI) than the low risk group SAS (7–10) mean CCI of 21.0 (5.3–36.2, 95% CI). There was a negative correlation between SAS and CCI, spearman r -0.575 (p < 0.001) and regression coefficient b − 11.5 (p < 0.001). SAS revealed a good accuracy for prediction of post-operative complication on ROC, Area under Curve 0.712 (0.523–0.902, 95% CI, p < 0.001). Conclusion We have demonstrated that SAS can accurately predict the occurrence of complications following emergency laparotomy at Muhimbili National Hospital.