BETHESDA, MD USA (UroToday.com) - Introduction/Objective: The Surgical Apgar Score (SAS) is an objective measure of the operative course based on EBL, lowest intraoperative heart rate and mean arterial pressure. It is a validated tool demonstrated to predict major complications and death following general/vascular surgery, where a lower SAS is associated with increasing rates of adverse postoperative events, but its use in urologic cohorts has been limited to date. We aimed to assess the performance of the SAS in patients undergoing radical cystectomy (RC).
Materials and Methods: Data for patients undergoing RC at a single institution from 2006-2011 was extracted from a prospectively collected database. Major complications (Clavien grade III or higher), readmissions, and deaths within 90 days of surgery were examined in addition to relevant preoperative data. SAS was calculated utilizing electronic anesthesia records.
Results: Of a final cohort of 308 patients, 32% of patients experienced a complication Clavien grade III or higher. The 90-day mortality rate was 6%. Major complications were associated with a significantly higher hospital length of stay (12 vs 8 days, p<0.0001) and readmission rate (54% vs 17%, p<0.0001). Lower SAS was significantly associated with readmission (SAS 6.0 vs 6.4, p=0.02) and trended towards having a significant association with 90-day mortality (SAS 5.6 vs 6.3, p=0.07) on univariate analysis. SAS however was not significantly associated with major complications. Significant predictors of 90-day mortality included advanced age (75 vs 68yo, p=0.004), lower preoperative hemoglobin (11.0 vs 12.6, p=0.0002) and lower preoperative albumin (3.5 vs 3.9, p=0.0008). Continent diversion was significantly associated with readmission (22% vs 13%, p=0.02). On multivariate analysis controlling for age, albumin, hemoglobin, and diversion type, SAS was an independent predictor of readmission (OR=0.81, p=0.02), and trended towards independent prediction of 90-day mortality (OR 0.74, p=0.06).
Conclusion: The SAS is associated with adverse postoperative outcomes in RC patients including postoperative readmission and 90-day mortality. Identification of patients who are at increased risk for readmission may allow for higher intensity post-operative management, and improve on overall post-RC patient outcomes. Prospective examination will further delineate the benefit for the SAS in the guidance of postoperative care in patients undergoing RC.
Presented by:
Timothy Ito,1 Philip Abbosh,1 Jason Mannion,2 Reza Mehrazin,1 Jeffrey Tomaszewski,1 Tianyu Li,1 Serge Ginzburg,3 Daniel Canter,3 Richard Greenberg,1 Rosalia Viterbo,1 David Chen,1 Alexander Kutikov,1 Marc Smaldone,1 and Robert Uzzo1
1 Fox Chase Cancer Center, Philadelphia, PA; 2 Temple University School of Medicine, Philadelphia, PA; 3 Einstein Healthcare Network, Philadelphia, PA
Presented at the 2014 Winter Meeting of the Society of Urologic Oncology (SUO) "Defining Excellence in Urologic Oncology" - December 3 - 5, 2014 - Bethesda, MD USA