• Darryl Lau, Timothy J Yee, Frank La Marca, Rakesh Patel, and Paul Park.
• *Department of Neurological Surgery, University of California-San Francisco, San Francisco, CA †Departments of Neurosurgery ‡Orthopedic Surgery, University of Michigan, Ann Arbor, MI.
• J Spinal Disord Tech. 2014 Oct 10.

Study Design:Retrospective review of consecutive patients who underwent surgery for spinal metastasis 2005-2011.Objective:To assess the utility of the surgical Apgar score (SAS) in patients who underwent surgery for spinal metastasis.Summary Of Background Data:Surgery for spinal metastasis can be associated with relatively high morbidity and mortality. Consequently, identifying patients at-risk for major postoperative complications is important. Several studies have validated SAS for predicting 30-day complication risk.Methods:SASs were calculated and patients stratified into 5 groups: scores 0-2, 3-4, 5-6, 7-8, 9-10 points. Multivariate logistic regression assessed whether SAS was an independent predictor of major complication 30 days following surgery. Multivariate ANCOVA assessed whether SAS was independently associated with length of stay.Results:Ninety-seven patients with a variety of metastatic tumors were analyzed. There was no obvious trend in complication rates, or significant association between SAS and complication rate (P=0.413). Complication rates were 25.0% for SASs 0-2, 33.3% for 3-4, 18.4% for 5-6, 10.0% for 7-8, and 33.3% for 9-10 points. On multivariate analysis, SAS was not independently associated with complications; age>65 years (OR 4.19; 95% CI, 1.31-52.27; P=0.028) and preoperative Karnofsky Performance Score of 10-40 (OR 9.13; 95% CI, 1.42-58.63; P=0.020) were associated with higher odds of complication. SASs 0-2 were an independent predictor of longer hospital stay (P=0.004).Conclusions:Our findings suggest SAS is not a significant predictor of major perioperative complications following spinal metastasis surgery; preoperative functional status and age are stronger predictors. The need continues for a preoperative scoring system to reliably predict risk for perioperative complications following spinal metastasis surgery.

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