Key result
The Surgical Apgar Score demonstrated good discriminatory power to predict major post-operative complications after single-level planned posterior lumbar interbody fusion (AUC 0.73).
Why the study?
Whether the Surgical Apgar Score can predict complications and patient-reported outcomes after posterior lumbar interbody fusion had not been evaluated.
Does the Surgical Apgar Score predict major postoperative complications and clinical outcomes in patients undergoing single-level posterior lumbar interbody fusion?
Cohort (n=815)
No
Does the Surgical Apgar Score predict major postoperative complications and clinical outcomes in patients undergoing single-level posterior lumbar interbody fusion?
Effect estimate: AUC 0.73 (95% CI 0.63-0.83)
p-value: p=<0.0001
The Surgical Apgar Score demonstrates good discriminatory power for predicting major postoperative complications following single-level posterior lumbar interbody fusion.
SAS may aid postoperative risk stratification after PLIF; leaves open prospective validation before routine adoption.
Background. The Surgical Apgar Score (SAS) has effectively prognosticated major complications in several surgeries including spine surgery. However, whether SAS can predict complications and patient reported outcomes after posterior lumbar interbody fusion (PLIF) has not been evaluated. The aim of this study was to analyze the relationship between SAS and clinical outcomes after PLIF. Methods. This research was retrospective clinical study. All patients who underwent a PLIF with singe-level, planned surgery from 2010 to 2022 were enrolled. Multilevel, revision, and unplanned PLIFs were excluded. Operative notes and anesthesia records were reviewed for estimated blood loss, lowest mean arterial pressure, and lowest heart rate. Japanese Orthopaedic Association (JOA) lumbar score and JOA improvement rate were recorded. Patients were divided into four groups by SAS (0–4, 5–6, 7–8, 9–10) and associated complications in each group were reviewed. A correlation coefficient between SAS and JOA improvement rate was also calculated. The receiver operating characteristic (ROC) analysis was used to evaluate the discriminatory power of SAS. Results. A total of 815 patients met study criteria. Major complications were reported for 33 patients. The incident rate of complications was 53.8% with SAS 0–4, 7% with SAS 5–6, 2.6% with SAS 7–8 and 0% with SAS 9–10, respectively. There were no reported deaths. Peripheral vascular disease (p = 0.01), moderate or severe renal disease (p = < 0.0001), diabetes with end organ damage (p = 0.01) and lymphoma (p = 0.02) were significantly more common in patients with major complications. The SAS and complications ROC reported an area under the curve of 0.73. The correlation coefficient between SAS and JOA improvement rate was weakly positive (r = 0.25). Conclusion. The data on this study shows SAS demonstrates good discriminatory power to predict post-operative complications. The relationship between SAS and JOA improvement rate is weakly positive.
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Shinohara et al. (2022) conducted a cohort in Lumbar degenerative disease (n=815). Surgical Apgar Score (SAS) vs. Different SAS groups (0-4, 5-6, 7-8, 9-10) was evaluated on Major postoperative complications (AUC 0.73, 95% CI 0.63-0.83, p=<0.0001). The Surgical Apgar Score demonstrated good discriminatory power to predict major post-operative complications after single-level planned posterior lumbar interbody fusion (AUC 0.73).
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