The significance of the modified surgical apgar score in predicting postoperative acute kidney injury among patients undergoing hepatectomy

Aim The incidence of acute kidney injury (AKI) following hepatectomy ranges from 0.9 % to 21.6 %. Postoperative AKI is associated with increased mortality, prolonged hospital stays, and more healthcare costs. Previous predictive models either neglected intraoperative factors or were excessively complicated for application. Based on estimated blood loss, minimum heart rate, and minimum mean arterial pressure, the Surgical Apgar Score (SAS) has been validated as an indicator of major complications and outcomes following surgeries. Furthermore, previous studies have linked hematocrit levels to the incidence of AKI. Our aim was to determine whether the modified SAS, calculated using both SAS and hematocrit, could accurately predict AKI following hepatectomy. Methods This retrospective study ultimately enrolled 960 patients who underwent hepatectomy. The study included a total of 28 preoperative and intraoperative variables. Univariate and multivariate logistic regression analyses were performed to determine the predictive ability of the modified SAS. Results We demonstrated significant associations between the modified SAS and the incidence of AKI (OR 0.65, 95 % CI 0.54-0.78, p < 0.001). A lower total score increases the likelihood of postoperative AKI, with a cutoff value set at 9. Conclusions The modified SAS appears to be a valid predictive factor for AKI following hepatectomy.