Use of the surgical Apgar score to guide postoperative care

被引：27

作者：

Haddow, J. B. ^{[1
]}

Adwan, H. ^{[1
]}

Clark, S. E. ^{[1
]}

Tayeh, S. ^{[1
]}

Antonowiez, S. S. ^{[1
]}

Jayia, P. ^{[1
]}

Chicken, D. W. ^{[1
]}

Wiggins, T. ^{[1
]}

Davenport, R. ^{[1
]}

Kaptanis, S. ^{[1
]}

Fakhry, M. ^{[1
]}

Knowles, C. H. ^{[1
]}

Elmetwally, A. S. ^{[1
]}

Geddoa, E. ^{[1
]}

Nair, M. S. ^{[1
]}

Naeem, I. ^{[1
]}

Adegbola, S. ^{[1
]}

Muirhead, L. J. ^{[1
]}

机构：

[1] London Surg Res Grp, London, England

来源：

ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND | 2014年 / 96卷 / 05期

关键词：

Postoperative complications; Decision support techniques; Prognostic impact study; PROGNOSTIC RESEARCH; RISK; SURGERY; MORTALITY; COMPLICATIONS; POPULATION; VALIDATION; MANAGEMENT; MORBIDITY; COHORT;

D O I：

10.1308/003588414X13946184900840

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

INTRODUCTION The surgical Apgar score (SAS) can predict 30-day major complications or death after surgery. Studies have validated the score in different patient populations and suggest it should be used to objectively guide postoperative care. We aimed to see whether using the SAS in a decisive approach in a future randomised controlled trial (ROT) would be likely to demonstrate an effect on postoperative care and clinical outcome. METHODS A total of 143 adults undergoing general/vascular surgery in 9 National Health Service hospitals were recruited to a pilot single blinded ROT and the data for 139 of these were analysed. Participants were randomised to a control group with standard postoperative care or to an intervention group with care influenced (but not mandated) by the SAS (decisive approach). The notional primary outcome was 30-day major complications or death. RESULTS Incidence of major complications was similar in both groups (control: 20/69 [29%], intervention: 23/70 [33%], p=0.622). Immediate admissions to the critical care unit was higher in the intervention group, especially in the SAS 0-4 subgroup (4/6 vs 2/7) although this was not statistically significant (p=0.310). Validity was also confirmed in area under the curve (AUC) analysis (AUC: 0.77). CONCLUSIONS This pilot study found that a future ROT to investigate the effect of using the SAS in a decisive approach may demonstrate a difference in postoperative care. However, significant changes to the design are needed if differences in clinical outcome are to be achieved reliably. These would include a wider array of postoperative interventions implemented using a quality improvement approach in a stepped wedge cluster design with blinded collection of outcome data.

引用

页码：352 / 358

页数：7

共 32 条

[1]

A New Vision, NEW VIS

[2]

Anderson I., 2011, The higher risk general surgical patient: towards improved care for a forgotten group, DOI [10.1016/j.dld.2008.01.008, DOI 10.1016/J.DLD.2008.01.008]

[3]

[Anonymous], 2008, DEV EVALUATING COMPL

[4] Surgical Apgar Score Predicts Perioperative Morbidity in Patients Undergoing Pancreaticoduodenectomy at a High-Volume Center [J].