Predicting Major Complications Following Laparotomy for Gastrointestinal Conditions Using Surgical Apgar Score: A Prospective Analysis in a Nigerian Population

BACKGROUND: Surgical Apgar score (SAS) is one of the risk assessment tools used in predicting postoperative complications. It is a simple and inexpensive tool composed of three intra-operative variables; lowest heart rate, lowest mean arterial blood pressure, and estimated blood loss, which are scored with a total of 10 points, based on which patients are risk stratified for developing post-operative complications. SAS was found to have good predictive accuracy for post-operative morbidity and mortality. The main objective of this study was to determine the efficacy of SAS in predicting major complications following laparotomy for gastrointestinal conditions. MATERIALS AND METHODS: The study was a prospective observational study, conducted in Aminu Kano Teaching Hospital, Kano, Nigeria. Eighty-three adult patients, who required laparotomy for gastrointestinal conditions were recruited. Data was collected using proforma, and patients were followed up for 30 days. The intra-operative parameters for SAS were scored, and according to the scores, patients were risk stratified for developing post-operative complications. The data were analyzed; sensitivity, specificity, and accuracy of the SAS were determined. RESULTS: A total of 83 patients were recruited in the study. About half (44.6%) of the patients developed major post-operative complications and a mortality rate of 7.2%. Most of the patients that died had low SAS. The sensitivity, specificity, accuracy, and AUC of SAS found were: 83.8%. 47.8%, 63.9% and 0.74 (95% CI; 0.63–0.84, P < 0.001) respectively. CONCLUSION: This study revealed that SAS is efficacious in predicting major complications following laparotomy for gastrointestinal conditions.