• Julio Urrutia, Macarena Valdes, Tomas Zamora, Valentina Canessa, and Jorge Briceno.
• Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile. Electronic address: jurrutia@med.puc.cl.
• Spine J. 2015 Jan 1;15(1):105-9.

Background ContextThe Surgical Apgar Score (SAS), a simple metric based on intraoperative heart rate, blood pressure, and blood loss, was developed in general and vascular surgery to predict 30-day major postoperative complications and mortality. No validation of SAS has been performed in spine surgery.PurposeTo perform a prospective assessment of SAS in spine surgery.Study DesignProspective study.Patient SampleTwo hundred sixty-eight consecutive patients undergoing major and intermediate spinal surgeries in an 18-month period.Outcome MeasuresOccurrence of major complications or death within 30 days of surgery.MethodsIntraoperative parameters were registered, and SAS was calculated immediately after surgery. Outcome data were collected during a 30-day follow-up. The relationship between SAS and the outcomes was analyzed calculating relative risks (RRs) and likelihood ratios (LRs) for different scoring groups. A univariate logistic regression analysis was also performed. The discriminatory accuracy of SAS was evaluated calculating a C-statistic.ResultsEighteen patients had ≥1 complications (6.72%). Patients with SAS 9-10 exhibited a 1.64% complication rate (RR=1; LR=0.23), which monotonically augmented as the score decreased: (SAS 7-8=2.75%; RR=1.68; LR=0.39), (SAS 5-6=13.33%; RR=8.13; LR=2.14), (SAS≤4=17.39%; RR=10.61; LR=2.92). The regression analysis odds ratio was 0.66 (95% confidence interval, 0.54-0.82), p<.01. The C-statistic was 0.77 (95% confidence interval, 0.66-0.88).ConclusionsSurgical Apgar Score allows risk stratification and has a good discriminatory power in patients undergoing spine surgery.Copyright © 2015 Elsevier Inc. All rights reserved.

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