"Surgical Apgar Score" predicts postoperative complications after cytoreduction for advanced ovarian cancer.

OBJECTIVE A 10-point "Surgical Apgar Score" (SAS) for predicting postoperative complications after general and vascular operations has recently been developed and validated. We sought to estimate the ability of this metric to predict major postoperative complications in women undergoing ovarian cancer cytoreductive procedures. METHODS All eligible patients with stage III and IV epithelial ovarian, fallopian tube and primary peritoneal cancer undergoing surgical cytoreduction at our institution between 1999 and 2005 were included. Medical records were reviewed and demographic data, clinicopathologic characteristics, comorbidities and intra and postoperative complications were analyzed. The surgical score was calculated from intraoperative blood loss, lowest mean arterial pressure and lowest heart rate as previously described. Descriptive statistics, univariable and multivariable analyses were used as appropriate. Occurrence of major postoperative complications represented the primary outcome. RESULTS A total of 232 cases were analyzed. Mean age was 62 years. Most patients were Caucasian (92%) and diagnosed with stage III disease (83%). Mean duration of surgical procedure was 171 (70-350) minutes. Median SAS was 6 points (range 1-9). On multivariable analyses, occurrence of major postoperative complications was associated with multiple comorbidities (OR 2.2; 95% CI:1.5-3.1; p<0.0001), stage IV disease (OR 2.5; 95% CI:1.1-5.7; p=0.03), ASA class (OR 2.4; 95% CI:1.2-4.7; p=0.01) and SAS<or=4 (OR 7.4; 95% CI:2.9-18.8; p<0.0001). CONCLUSIONS Lower SAS (<or=4) is the most powerful predictor of postoperative complications in patients undergoing cytoreductive surgery for advanced epithelial ovarian cancer. This prognostic tool may prove helpful for triaging such patients to optimal postoperative levels of care and directing counseling, monitoring and management in the postoperative period.

[1]  S. Lipsitz,et al.  Does the Surgical Apgar Score Measure Intraoperative Performance? , 2008, Annals of surgery.

[2]  E. Venkatraman,et al.  Guidelines and selection criteria for secondary cytoreductive surgery in patients with recurrent, platinum‐sensitive epithelial ovarian carcinoma , 2006, Cancer.

[3]  D. Levine,et al.  The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC-IV epithelial ovarian cancer. , 2006, Gynecologic oncology.

[4]  Mary R. Kwaan,et al.  An Apgar score for surgery. , 2007, Journal of the American College of Surgeons.

[5]  L. Tanoue.  Cancer Statistics, 2009 , 2010 .

[6]  Claus Dethlefsen,et al.  The impact of comorbidity and stage on ovarian cancer mortality: A nationwide Danish cohort study , 2008, BMC Cancer.

[7]  Jesse M. Ehrenfeld,et al.  Utility of the surgical apgar score: validation in 4119 patients. , 2009, Archives of surgery.

[8]  P. Baade,et al.  Elderly patients with stage III or IV ovarian cancer: should they receive standard care? , 2007, International Journal of Gynecologic Cancer.

[9]  C. Gross,et al.  Participation in Surgical Oncology Clinical Trials: Gender-, Race/Ethnicity-, and Age-based Disparities , 2007, Annals of Surgical Oncology.

[10]  A. Obermair,et al.  Clinical audit in gynecological cancer surgery: development of a risk scoring system to predict adverse events. , 2009, Gynecologic oncology.

[11]  D. Mutch,et al.  Correlates of length of stay in gynecologic oncology patients undergoing inpatient surgery. , 1993, Gynecologic oncology.

[12]  N. Dubrawsky.  Cancer statistics , 1989, CA: a cancer journal for clinicians.

[13]  W. Cliby,et al.  Relationship among surgical complexity, short-term morbidity, and overall survival in primary surgery for advanced ovarian cancer. , 2007, American journal of obstetrics and gynecology.

[14]  D. Chi,et al.  Delaying the primary surgical effort for advanced ovarian cancer: a systematic review of neoadjuvant chemotherapy and interval cytoreduction. , 2007, Gynecologic oncology.

[15]  W. Cliby,et al.  Quality improvement in the surgical approach to advanced ovarian cancer: the Mayo Clinic experience. , 2009, Journal of the American College of Surgeons.

[16]  L. Landrum,et al.  Ovarian cancer in the octogenarian: does the paradigm of aggressive cytoreductive surgery and chemotherapy still apply? , 2008, Gynecologic oncology.

[17]  D. Levine,et al.  Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm. , 2009, Gynecologic oncology.

[18]  S. Rubin,et al.  Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: a Gynecologic Oncology Group Study. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[19]  D. Levine,et al.  Response and outcomes in elderly patients with stages IIIC-IV ovarian cancer receiving platinum-taxane chemotherapy. , 2007, Gynecologic oncology.

[20]  E. Trimble,et al.  Survival Effect of Maximal Cytoreductive Surgery for Advanced Ovarian Carcinoma During the Platinum Era: A Meta-Analysis. , 2023, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  Use of the APACHE II Scoring System to Determine Mortality of Gynecologic Oncology Patients in the Intensive Care Unit , 1995, Obstetrics and gynecology.

[22]  D. Chi,et al.  A new frontier for quality of care in gynecologic oncology surgery: multi-institutional assessment of short-term outcomes for ovarian cancer using a risk-adjusted model. , 2007, Gynecologic oncology.