• Scott E Regenbogen, Jesse M Ehrenfeld, Stuart R Lipsitz, Caprice C Greenberg, Matthew M Hutter, and Atul A Gawande.
• Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA. sregenbogen@partners.org
• Arch Surg. 2009 Jan 1;144(1):30-6; discussion 37.

ObjectivesTo confirm the utility of a 10-point Surgical Apgar Score to rate surgical outcomes in a large cohort of patients.DesignUsing electronic intraoperative records, we calculated Surgical Apgar Scores during a period of 2 years (July 1, 2003, through June 30, 2005).SettingMajor academic medical center.PatientsSystematic sample of 4119 general and vascular surgery patients enrolled in the National Surgical Quality Improvement Program surgical outcomes database at a major academic medical center.Main Outcome MeasuresIncidence of major postoperative complications and/or death within 30 days of surgery.ResultsOf 1441 patients with scores of 9 to 10, 72 (5.0%) developed major complications within 30 days, including 2 deaths (0.1%). By comparison, among 128 patients with scores of 4 or less, 72 developed major complications (56.3%; relative risk, 11.3; 95% confidence interval, 8.6-14.8; P < .001), of whom 25 died (19.5%; relative risk, 140.7; 95% confidence interval, 33.7-587.4; P < .001). The 3-variable score achieves C statistics of 0.73 for major complications and 0.81 for deaths.ConclusionsThe Surgical Apgar Score provides a simple, immediate, objective means of measuring and communicating patient outcomes in surgery, using data routinely available in any setting. The score can be effective in identifying patients at higher- and lower-than-average likelihood of major complications and/or death after surgery and may be useful for evaluating interventions to prevent poor outcomes.

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