Predicting Major Complications Following Emergency Laparotomy for Gastrointestinal Conditions Using Surgical Apgar score

Abstract

Background: Emergency laparotomy is a common surgical operation, and is associated with high postoperative morbidity and mortality. The mortality within 30 days following emergency laparotomy ranged from 13% to 18%. Surgical Apgar Score (SAS) is a simple, inexpensive, and easily utilizable tool for predicting postoperative complications using only three intraoperative parameters, and has good predictive accuracy.  This study aimed to determine the ability of SAS in predicting major complications following laparotomy for gastrointestinal conditions. Patients and Method: This is a prospective observational study conducted in Aminu Kano Teaching Hospital, where adult patients who consented and met the indication for emergency laparotomy were enrolled for 1 year. The patient's demographic and clinical characteristics were obtained using a proforma. The patients were categorized into high-risk, moderate-risk, and low-risk based on the surgical Apgar score and followed up for 30 days. Patients’ data were analyzed, Receiver Operating Characteristics (ROC) curve was generated and Area under the Curve (AUC) was calculated. Results: Fifty-seven adult patients were studied. The rate of major postoperative complications was 50.88% and 30-day postoperative mortality of 10.53%. The mortality rate was 25.00% in the high-risk group, while in the moderate-risk group was 15.38%, and no mortality was recorded in the low-risk group. The AUC of 0.72 (95% CI: 0.58- 0.85; p< 0.01) was obtained from the study. Conclusions: Surgical Apgar score has good predictive accuracy in predicting major complications following emergency laparotomy for gastrointestinal conditions.