Copyright
©The Author(s) 2016.
World J Orthop. Dec 18, 2016; 7(12): 832-838
Published online Dec 18, 2016. doi: 10.5312/wjo.v7.i12.832
Published online Dec 18, 2016. doi: 10.5312/wjo.v7.i12.832
Table 1 Calculation of surgical apgar score
| 0 point | 1 point | 2 points | 3 points | 4 points | |
| Estimated blood loss, mL | > 1000 | 601-1000 | 101-600 | < 100 | - |
| Lowest mean arterial pressure, mmHg | < 40 | 40-54 | 55-69 | > 70 | - |
| Lowest heart rate, beats per min | > 85 | 76-85 | 66-75 | 56-65 | < 55 |
Table 2 Pre-operative characteristics
| All patients (n = 170) | TTA patients (n = 70) | TFA patients (n = 100) | P-value | |
| Sex (women/men) | 74/96 | 26/44 | 48/52 | 0.21 |
| % | (44/56) | (37/63) | (48/52) | |
| Age, yrs | 74 (12) | 72 (12) | 76 (12) | 0.01 |
| Body mass index | 24.5 (6.5) | 24.9 (5.3) | 24.2 (7.2) | 0.47 |
| Cause for amputation | ||||
| Diabetes/arteriosclerosis/other | 58/105/7 | 30/36/4 | 28/69/3 | 0.03 |
| % | (34/62/4) | (43/51/6) | (28/69/3) | |
| ASA-groups, 1-2/3-4 | 25/142 | 16/54 | 9/88 | 0.03 |
| % | (15/84) | (23/77) | (9/88) | |
| Dementia | 20 (12) | 6 (9) | 14 (14) | 0.34 |
| Cardiovascular disease | 46 (27) | 22 (31) | 24 (24) | 0.30 |
| Pulmonary disease | 30 (18) | 12 (17) | 18 (18) | 1.00 |
| Cerebral apoplexy | 40 (24) | 11 (16) | 29 (29) | 0.07 |
| Kidney disease | 45 (26) | 17 (24) | 28 (28) | 0.72 |
| Diabetes mellitus | 72 (42) | 37 (53) | 35 (35) | 0.02 |
| Diagnosed with cancer | 14 (8) | 6 (9) | 8 (8) | 1.00 |
| Transfused preoperatively (patients) | 34 (20) | 10 (14) | 24 (24) | 0.17 |
| NSAID or acetylsalicylic acid (yes) | 82 (48) | 38 (54) | 44 (44) | 0.21 |
| Clopidogrel (yes) | 35 (21) | 13 (19) | 22 (22) | 0.70 |
| Preoperative hemoglobin, g/L (SD) | 108 (16.1) | 108 (16.1) | 106 (16.1) | 0.48 |
| Preoperative thrombocytes (SD) | 354 (151) | 366 (157) | 345 (146) | 0.46 |
Table 3 Intraoperative characteristics
| All patients (n = 170) | TTA patients (n = 70) | TFA patients (n = 100) | P-value | |
| Bilateral amputation procedure | 9 (5) | 4 (6) | 5 (5) | |
| Rank of surgeon, resident/consultant % | 116/54 | 45/25 | 71/29 | 0.40 |
| (68/32) | (64/36) | (71/29) | ||
| Duration of surgery, minutes (SD) | 81 (23) | 85 (26) | 79 (20) | 0.06 |
| Neuraxial/general anesthesia | 121/49 | 56/14 | 65/35 | 0.04 |
| % | (71/29) | (80/20) | (65/35) | |
| Vasopressor agents during surgery (yes) | 106 | 37 (52) | 69 (69) | 0.037 |
| Tourniquet use (yes) | 49 (29) | 35 (50) | 11 (11) | < 0.001 |
| Initial heart rate (beats/min) (SD) | 85 (16) | 84 (15) | 85 (17) | 0.77 |
| Initial blood pressure (mmHg) | Sys: 131 (21) | Sys: 131 (20) | Sys: 131 (21) | 0.83 |
| Dia: 73 (13) | Dia: 74 (13) | Dia: 73 (12) | 0.552 | |
| Lowest heart rate (beats/min) | 72 (SD: 1.2) | 70 (SD: 1.9) | 74 (SD: 1.5) | 0.13 |
| Lowest mean arterial pressure (mmHg) | 64 (SD: 0.9) | 65 (SD: 1.4) | 64 (SD: 1.1) | 0.32 |
| Estimated blood loss (mL), median (IQR) | 300 (IQR: 125-475) | 248 (IQR: 88-408) | 400 (IQR: 231-569) | 0.15 |
| Perioperative blood lactate (SD) | 1.2 (1.2) | 1.0 (0.5) | 1.3 (1.5) | 0.33 |
| Perioperative acid-base balance (SD) | 7.39 (0.01) | 7.41 (0.05) | 7.38 (0.09) | 0.05 |
Table 4 Surgical APGAR score complications (%)
| Total (n = 170) | TTA group (n = 70) | TFA group (n = 100) | |
| Death | 30 (18) | 9 (13) | 21 (21) |
| Bleeding requiring ≥ 4 units of RBC transfusion within 3 d following operation | 28 (16) | 7 (10) | 21 (21) |
| Sepsis | 12 (7) | 4 (6) | 8 (8) |
| Acute myocardial infarction/acute heart failure | 7 (4) | 0 (0) | 7 (7) |
| Acute renal failure | 6 (4) | 1 (1) | 5 (5) |
| Pneumonia | 18 (11) | 5 (7) | 13 (13) |
| Stroke | 1 (1) | 0 (0) | 1 (1) |
| Pulmonary embolism | 0 (0) | 0 (0) | 0 (0) |
Table 5 Logistic regression analysis of surgical APGAR score groups and complications/death
| Score | SAS 9-10 | SAS 7-8 | SAS 5-6 | SAS 0-4 |
| All patients (%) | 5 (3) | 57 (34) | 70 (41) | 38 (22) |
| Complications and deaths within SAS group (%) | 1 (20) | 14 (25) | 29 (41) | 22 (58) |
| Odds Ratio between groups (reference SAS 9-10) | (ref.) | OR = 1.30 CI: 0.13-12.64 P = 0.82 | OR = 2.83 CI: 0.30-26.64 P = 0.36 | OR = 5.50 CI: 0.56-53.99 P = 0.143 |
| Linearity of the model, OR (95%CI), P-value | 2.00 (CI: 1.33-3.03) P = 0.001 | |||
| Transfemoral procedure, n = 100 (%) | 4 (4) | 31 (31) | 38 (38) | 27 (27) |
| Complications and deaths within SAS group (%) | 1 (25) | 8 (26) | 17 (45) | 20 (74) |
| Odds ratio between groups (reference SAS 9-10) | (ref.) | OR = 1.04 CI: 0.10-11.52 P = 0.97 | OR = 2.43 CI: 0.23-25.51 P = 0.46 | OR = 8.57 CI: 0.76-96.52 P = 0.08 |
| Linearity of the model, OR (95%CI), P-value | 2.61 (CI: 1.52-4.47) P < 0.001 | |||
| Transtibial procedure, n = 70 (%) | 1 (1) | 26 (37) | 32 (46) | 11 (16) |
| Complications and deaths within SAS group (%) | 0 (0) | 6 (23) | 12 (38) | 2 (18) |
| Odds Ratio between groups (reference SAS 7-8) | 1 | (ref.) | OR = 0.74 CI: 0.13-4.41 P = 0.74 | OR = 2.00 CI: 0.63-6.38 P = 0.24 |
| Linearity of the model, OR (95%CI), P-value | 1.12 (CI: 0.55-2.29) P = 0.76 | |||
- Citation: Wied C, Foss NB, Kristensen MT, Holm G, Kallemose T, Troelsen A. Surgical apgar score predicts early complication in transfemoral amputees: Retrospective study of 170 major amputations. World J Orthop 2016; 7(12): 832-838
- URL: https://www.wjgnet.com/2218-5836/full/v7/i12/832.htm
- DOI: https://dx.doi.org/10.5312/wjo.v7.i12.832