873 DOES THE SURGICAL APGAR OUTCOME SCORE ACCURATELY PREDICT SHORT-TERM POSTOPERATIVE OUTCOMES FOLLOWING ROBOT-ASSISTED RADICAL CYSTECTOMY?

Abstract

You have accessJournal of UrologyBladder Cancer: Basic Research1 Apr 2011873 DOES THE SURGICAL APGAR OUTCOME SCORE ACCURATELY PREDICT SHORT-TERM POSTOPERATIVE OUTCOMES FOLLOWING ROBOT-ASSISTED RADICAL CYSTECTOMY? Andrew P. Stegemann, Bilal Mahmood, Kevin P. Krul, Matthew H. Hayn, Mohamed A. Sharif, Rameela Chandrasekhar, Gregory E. Wilding, and Khurshid A. Guru Andrew P. StegemannAndrew P. Stegemann Buffalo, NY More articles by this author , Bilal MahmoodBilal Mahmood Buffalo, NY More articles by this author , Kevin P. KrulKevin P. Krul Buffalo, NY More articles by this author , Matthew H. HaynMatthew H. Hayn Buffalo, NY More articles by this author , Mohamed A. SharifMohamed A. Sharif Buffalo, NY More articles by this author , Rameela ChandrasekharRameela Chandrasekhar Buffalo, NY More articles by this author , Gregory E. WildingGregory E. Wilding Buffalo, NY More articles by this author , and Khurshid A. GuruKhurshid A. Guru Buffalo, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.697AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A 10-point surgical Apgar scoring system to predict postoperative course has previously been used in general and vascular surgery populations, and with patients undergoing radical cystectomy. This scoring system specifically evaluated estimated blood loss (EBL), lowest mean arterial pressure, and lowest heart rate as predictors of postoperative complications or death. Due to differences in operative parameters during robot-assisted surgery, we applied this score and a modified version to determine if they predicted major complications or death following robot-assisted radical cystectomy (RARC). METHODS One hundred and ninety-one patients who underwent RARC between 2005 and 2010 were prospectively reviewed. A major complication was defined as grade 3 or greater using the Modified Clavien grading system. The previously described surgical Apgar score was calculated, as well as a modified score to evaluate the effect of reduced blood loss in our patient population. Patients were categorized according to surgical Apgar score. Chi-square analysis was used to determine the significance of patient and operative parameters on surgical outcome. RESULTS One hundred twenty-nine patients (76%) were male. Median EBL was 400mL (range 50–3900) and 17% of patients required a blood transfusion. Twenty-two patients (12%) experienced a major complication or death within 30 days of surgery. The median age of patients without a major complication (69 years, range 36-90) was significantly lower than the median age of patients with a major complication (76 years, range 50–90) (p=0.0027). EBL, lowest mean arterial pressure and lowest heart rate were not predictive of major complications or death (p=0.2513, p=0.8350, and p=0.1209, respectively). The previously reported surgical Apgar score and the adjusted score did not predict major complications or death (p=.7561 and p=.1751, respectively). CONCLUSIONS The surgical Apgar outcome score did not predict postoperative complications or mortality after RARC in this cohort. Although it has been shown to work reliably in other applications, the reliance of this score on estimated blood loss may give this predictor less relevance with minimally invasive procedures. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e349-e350 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew P. Stegemann Buffalo, NY More articles by this author Bilal Mahmood Buffalo, NY More articles by this author Kevin P. Krul Buffalo, NY More articles by this author Matthew H. Hayn Buffalo, NY More articles by this author Mohamed A. Sharif Buffalo, NY More articles by this author Rameela Chandrasekhar Buffalo, NY More articles by this author Gregory E. Wilding Buffalo, NY More articles by this author Khurshid A. Guru Buffalo, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...