• Rachel M Clark, Malinda S Lee, J Alejandro Rauh-Hain, Tracilyn Hall, David M Boruta, Marcela G del Carmen, Annekathryn Goodman, John O Schorge, and Whitfield B Growdon.
• Division of Gynecologic Oncology, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA 02114, United States; Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School, Boston, MA 02115, United States. Electronic address: rmclark@partners.org.
• Gynecol. Oncol. 2015 Mar 1;136(3):516-20.

ObjectiveTo validate whether Surgical Apgar Score can predict post-operative morbidity in patients undergoing hysterectomies for malignancies.MethodsWe conducted a retrospective cohort study of consecutive hysterectomies performed for cancer at a single academic institution between 2008 and 2010. The Surgical Apgar Score (SAS) was derived as previously reported. Peri-operative complications were as outlined by the American Board for Obstetrics and Gynecology, and then further subdivided into intra-operative and post-operative events. Univariate and multivariate logistic regressions were utilized.ResultsA total of 632 patients were identified. Of our cohort, 64% underwent surgery for cancer arising in the uterus, followed by ovary at 28.6% and cervix at 4%. Median patient age was 60 years old with a mean American Society of Anesthesiologists Physical Status Classification System (ASA) score of 2.5 and a median body mass index of 29. Average Surgical Apgar Score was 7.6. As SAS decreased, the risk of peri-operative complications increased (p<0.01). On univariate analysis SAS could predict for both intra-operative and post-operative complications. However, on multivariate analyses SAS could not independently predict for any post-operative complications (OR 1.02, CI 0.47-2.17). In a multivariable model incorporating age, ASA class, SAS <4, disease site, bowel resection and laparotomy, only ASA class and laparotomy were able to predict for postoperative complication events.ConclusionsLow Surgical Apgar Score significantly associates with morbidity in women undergoing hysterectomy for malignancy, but is unable to predict which patients will have postoperative complications. This renders the SAS less helpful for the creation of peri-operative metrics to guide post-operative care.Copyright © 2014 Elsevier Inc. All rights reserved.

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