PD43-09 THE SURGICAL APGAR SCORE IS AN INDEPENDENT PREDICTOR OF HIGH COMPLICATION BURDEN FOLLOWING RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI1 Apr 2016PD43-09 THE SURGICAL APGAR SCORE IS AN INDEPENDENT PREDICTOR OF HIGH COMPLICATION BURDEN FOLLOWING RADICAL PROSTATECTOMY Björn Löppenberg, Matthias Orberger, Florian Roghmann, Christian von Bodman, Marko Brock, Joachim Noldus, and Jüri Palisaar Björn LöppenbergBjörn Löppenberg More articles by this author , Matthias OrbergerMatthias Orberger More articles by this author , Florian RoghmannFlorian Roghmann More articles by this author , Christian von BodmanChristian von Bodman More articles by this author , Marko BrockMarko Brock More articles by this author , Joachim NoldusJoachim Noldus More articles by this author , and Jüri PalisaarJüri Palisaar More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1787AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Easily applicable models which evaluate the postoperative risk of complications are rare. We set to evaluate the practicability of the surgical APGAR score (SAS) to predict patient overall complication burden assessed by the comprehensive complication index (CCI) in robotic (RRP) and open retropubic (ORP) radical prostatectomy (RP). METHODS In patients with RRP or ORP between October 2010 and March 2013 at a single academic center, the SAS was calculated from intraoperative lowest heart-rate, blood loss and lowest mean arterial blood pressure. All complications within 30 days after RP were summarized to the CCI. Descriptive and logistic regression analyses were performed, to assess the capability of the SAS to predict total complication burden. A cut-off for the SAS was set according to decision tree analysis and CCI was categorized in 0 (none), ≤8.7 (low), >8.7 to ≤26.2 (intermediate), and >26.2 (high). The model was adjusted for age, type of surgery, and body-mass index. RESULTS We evaluated 994 RP, consisting of 22% (219/994) RRP and 78% (775/994) ORP. An extended pelvic lymphadenctomy was performed in 54.8% (554/994) of the cases. The overall complication rate was 45.4% (451/994). Complication rates were 29.9% (66/221) and 49.9% (392/785) for robotic and open radical prostatectomy, respectively (p<0.0001). The mean CCI was 9.94±13.7. Rates of CCI low, intermediate and high were 12.5% (124/994), 21.7% (216/994) and 11.2% (111/994), respectively. The mean SAS was 7.02±1.19, 31.8% (316/994) and 68.2% (678/994) had a SAS of ≤6 and >6, respectively. Mean SAS in patients with none, low, intermediate, or high complication burden was 7.18±1.13, 6.86±1.2, 6.91±1.35, and 6.62±1.18, respectively (p<0.0001). Of those with a SAS ≤6 43.4% (137/316), 13.3% (42/316), 25.9% (82/316), and 17.4% (55/316) had none, low, intermediate or high complication burden, respectively. In the univariate analysis SAS ≤6 was associated with intermediate (odds ratio OR 1.81, 95% confidence interval CI 1.29-2.54 p<0.001) and high (OR 2.91, 95% CI 1.91-4.43 p<0.0001) complication burden. In the multivariate analysis SAS ≤6 was an independent predictor of intermediate (OR 1.79, 95% CI 1.26-2.56 p<0.001) and high (OR 2.31, 95% CI 1.49-3.58 p<0.0001) complication burden, respectively. CONCLUSIONS The SAS is easily calculated from intraoperative available data. Immediatly after surgery patients whith increased risk for a high 30-day complication burden are identified as these are predicted by a SAS ≤6. The surgeon and the anaesthesiologist should avoid low SAS values during the procedure. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e995-e996 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Björn Löppenberg More articles by this author Matthias Orberger More articles by this author Florian Roghmann More articles by this author Christian von Bodman More articles by this author Marko Brock More articles by this author Joachim Noldus More articles by this author Jüri Palisaar More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...