Key result
Preoperative frailty linked to lower median surgical Apgar scores in older abdominal cancer patients.
Why the study?
The applicability of the surgical Apgar score in frail patients with minimal hemodynamic variation undergoing abdominal cancer surgery was unknown.
Is preoperative frailty associated with a lower surgical Apgar score in older patients undergoing elective major abdominal cancer surgery?
Observational (n=210)
No
Is preoperative frailty associated with a lower surgical Apgar score in older patients undergoing elective major abdominal cancer surgery?
Absolute Event Rate: 7% vs 8%
p-value: p=0.03
Preoperative frailty is associated with a lower surgical Apgar score, which in turn correlates with higher postoperative complication rates and longer hospital stays in older patients undergoing abdominal cancer surgery.
May warrant enhanced monitoring in frail older abdominal cancer surgery patients; hypothesis-generating for whether frailty modification improves outcomes.
INTRODUCTION: The surgical Apgar score is useful for predicting postoperative morbidity and mortality. However, its applicability in frail patients with minimal hemodynamic variation remains unknown. This study aimed to investigate the association between frailty and surgical Apgar score. METHODS: This secondary analysis included 210 patients ≥ 65 years of age undergoing elective major abdominal surgery for cancer. Frailty was assessed using the Fried Frailty Phenotype Questionnaire and defined as a total score of ≥ 3. The surgical Apgar score (range, 0-10; including mean blood pressure, heart rate, and blood loss volume) was compared between patients with or without frailty using the Mann-Whitney U test. Postoperative severe complications and length of postoperative stay were compared between patients with surgical Apgar scores ≤ 7 and > 7. RESULTS: Among the included patients, 45 were classified as frail. The median [1st quartile, 3rd quartile] surgical Apgar scores in patients with and without frailty were 7.0 [7.0, 8.0] and 8.0 [7.0, 8.0], respectively (P = 0.03). Patients with surgical Apgar score ≤7 had a higher incidence of serious postoperative complications (P = 0.03) and longer hospital stays (P < 0.001) compared with patients with surgical Apgar score >7. CONCLUSION: Frail patients have lower SAS, and patients with lower SAS have higher postoperative complication rates and longer hospital stays in patients who underwent cancer surgery.
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Hirai et al. (2024) conducted an observational in Abdominal cancer (n=210). Preoperative frailty vs. Robust (without frailty) was evaluated on Surgical Apgar score (SAS) (p=0.03). Preoperative frailty was associated with a significantly lower median surgical Apgar score (7.0 vs 8.0, P=0.03) in older patients undergoing abdominal cancer surgery.
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