Would surgical Apgar score be useful to predict postoperative complications after proximal femoral fracture surgery?- A retrospective cohort study

Background: The surgical Apgar score (SAS) is a perioperative risk evaluation score, which consi-ders intraoperative minimum heart rate, minimum mean arterial pressure and estimated blood loss. Although validated in multiple surgical fields, SAS remains quite controversial in the ortho-pedic one. The main purpose of this study was to investigate if SAS relates with the occurrence of complications during the first 30-days after proximal femoral fracture surgery. Methods: Retrospective study including all consecutive patients submitted to proximal femoral fracture surgery between January and July 2019. Patients with no information about SAS were excluded. Patients were divided in two groups, based on the occurrence of complications during the first 30 post-operative days and their SAS calculated. Receiver operating characteristic (ROC) curves were used to assess SAS power as a predictive model of complications. Results: Forty-two percent (n = 76) of the 181 patients included in the study developed complications during the first 30 postoperative days. Eight patients (4,4%) died during that period. The patient's mean age was 79 years and 30,9% (n = 56) were men. Heart failure, pace-maker use, chronic kidney disease, chronic obstructive pulmonary disease and dementia were significantly associated with post-operative morbidity. There was no significant correlation bet-ween SAS and the occurrence of complications during the first 30 postoperative days. The AUC of SAS as a predictive model for postoperative complications after proximal femoral fracture surgery was 0,522, being insufficient to be considered an accepted model of prediction. Conclusion: Based on this study, we conclude that SAS is not predictive of the development of complications in the first 30 post-operative days in patients submitted to proximal femoral fracture surgery. However, other clinical factors have been identified as associated with pos-toperative morbidity. In the future, prospective-based studies with higher samples may better clarify the role of SAS in this context. (c) 2022 Sociedad Espan similar to ola de Anestesiologi ' a, Reanimacion y Terapeutica del Dolor. Published by Elsevier Espan similar to a, S.L.U. All rights reserved.