Outcome Prediction of Patients Undergoing Laparotomy using Surgical Apgar Score

Objective: To evaluate the predictive accuracy of the Surgical Apgar Score (SAS) in determining 30-day postoperative morbidity and mortality among adult patients undergoing laparotomy in a tertiary care setting inKarachi, Pakistan.Methods: This prospective observational study was conducted at Jinnah Postgraduate Medical Centre from July to December 2025. A total of 105 patients aged eighteen years or older undergoing elective or emergency laparotomy were enrolled using non-probability consecutive sampling. The SAS (range 0–10) was calculated immediately after surgery using the lowest intraoperative heart rate, lowest mean arterial pressure, and estimated blood loss. Patients were categorized into low-risk (7–10), moderate-risk (5–6), and high-risk (≤4)groups. Postoperative outcomes, including morbidity and 30-day mortality, were analyzed using Chi-square/Fisher Exact and Kruskal-Wallis tests.Results: Of total 105 patients, the median age was 47.0 years (40.5-55.5). Most patients were classified as moderate risk 66 (62.9%) based on the SAS, followed by low 21 (20.0%) and high risk 18 (17.1%). Postoperative complications occurred in 37 (35.2%) patients, with a 30-day mortality of 12 (11.4%). Surgical site infection (p-value < 0.001), overall complications (p-value = 0.041), and 30-day mortality (p-value = 0.005) were significantly higher in patients with moderate to higher SAS risk levels. ROC curve analysis demonstrated a fair predictive ability of SAS for 30-day mortality, with an AUC of 0.702.Conclusion: The SAS was significantly associated with postoperative morbidity and 30-day mortality, with higher risk levels showing increased adverse outcomes, and demonstrated fair predictive ability.