Abstract
BackgroundAlthough there has been marked development in surgical techniques, there is no easy and fast method of predicting complications in minimally invasive surgeries. We evaluated whether the modified surgical Apgar score (MSAS) could predict perioperative complications in patients undergoing robotic-assisted radical hysterectomy.MethodsAll patients with cervical cancer undergoing robotic-assisted radical hysterectomy at our institution between January 2011 and May 2017 were included. Their clinical characteristics were retrieved from their medical records. The surgical Apgar score (SAS) was calculated from the estimated blood loss, lowest mean arterial pressure, and lowest heart rate during surgery. We modified the SAS considering the lesser blood loss typical of robotic surgeries. Perioperative complications were defined using a previous study and the Clavien-Dindo classification and subdivided into intraoperative and postoperative complications. We analyzed the association of perioperative complications with low MSAS.ResultsA total of 138 patients were divided into 2 groups: with (n = 53) and without (n = 85) complications. According to the Clavien-Dindo classification, 49 perioperative complications were classified under Grade I (73.1%); 13, under Grade II (19.4%); and 5, under Grade III (7.5%); 0, under both Grade IV and Grade V. Perioperative complications were significantly associated with surgical time (p = 0.026). The MSAS had a correlation with perioperative complications (p = 0.047). The low MSAS (MSAS, ≤6; n = 52) group had significantly more complications [40 (76.9%), p = 0.01]. Intraoperative complications were more correlated with a low MSAS than were postoperative complications [1 (1.2%) vs. 21 (40.4%); p < 0.001, 13 (15.1%) vs. 25 (48.1%); p = 0.29, respectively]. We also analyzed the risk-stratified MSAS in 3 subgroups: low (MSAS, 7–10), moderate (MSAS 5–6), and high risks (MSAS, 0–4). The prevalence of intraoperative complications significantly increased as the MSAS decreased p = 0.01).ConclusionsThis study was consistent the concept that the intuitive and simple MSAS might be more useful in predicting intraoperative complications than in predicting postoperative complications in minimally invasive surgeries, such as robotic-assisted radical hysterectomy for cervical cancer.
Highlights
There has been marked development in surgical techniques, there is no easy and fast method of predicting complications in minimally invasive surgeries
Since the introduction of radical hysterectomy using robots in patients with early-stage cervical cancer, robotic-assisted radical hysterectomy has been rapidly adopted in gynecologic oncology
According to the Clavien-Dindo classification, 49 perioperative complications were classified under Grade I (73.1%); 13, under Grade II (19.4%); and 5, under Grade III (7.5%); 0, under both Grade IV and Grade V
Summary
There has been marked development in surgical techniques, there is no easy and fast method of predicting complications in minimally invasive surgeries. We evaluated whether the modified surgical Apgar score (MSAS) could predict perioperative complications in patients undergoing robotic-assisted radical hysterectomy. Robotic-assisted radical hysterectomy yields a shorter surgical time, lesser blood loss, shorter hospital stay, faster recovery, less postoperative pain, and fewer complications than does traditional abdominal radical hysterectomy and laparoscopic-assisted radical hysterectomy [1,2,3]. Predicting postoperative complications improves the quality of care by increasing patient satisfaction and reducing the readmission rate and medical resource wasting [4]. In 1953, the neonatal Apgar score was introduced and has brought a considerable change the prediction of neonatal outcomes [5]. The SAS, a 10-point scoring system, comprises 3 components: estimated blood loss (EBL), mean arterial pressure (MAP), and heart rate (HR) during surgery. The SAS ranges from 0 to 10; a low SAS indicates poor outcomes as in the neonatal Apgar score
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