Accuracy of Surgical APGAR Score in Predicting the Severity of Postoperative Complications Following Emergency Abdominal Surgery

Abstract

Objective: The objective of this study was to determine the accuracy of the Surgical Apgar Score in predicting the severity of postoperative complications following emergency abdominal surgery, using actual postoperative events as the gold standard.

Methodology: A total of 231 patients aged 14–75 years undergoing emergency abdominal surgery under general anesthesia were enrolled using consecutive sampling. Variables such as intra-operative lowest heart rate, least MAP (mean arterial pressure) as well as estimated blood loss were recorded in order to calculate the SAS. Complications following surgery were classified in accordance with the Clavien–Dindo Classification over a 30-day follow-up. Diagnostic accuracy of SAS was calculated by specificity, sensitivity, PPV (positive predictive value) , NPP (negative predictive value), as well as the ROC (receiver operating characteristic) curve analysis. Data were stratified by demographic and clinical factors to evaluate the consistency of SAS performance.

Results: The mean SAS was 5.8 ± 2.9. High-grade complications (Clavien–Dindo III–V) occurred in 47.2% of patients. SAS shown with sensitivity = 74.3%, specificity = 67.2%, PPV = 58.3%, NPV = 80.4%, and diagnostic accuracy = 69.7%. The area under curve was 0.75 (95% CI: 0.69–0.81, p < 0.001). Stratified analyses confirmed stable performance across subgroups.

Conclusion: The Surgical Apgar Score is a reliable, simple tool that can predict the severity of postoperative complications after emergency abdominal surgery, facilitating early risk stratification and guiding perioperative care.

Keywords: Clavien–Dindo Classification, Diagnostic Accuracy, Emergency Abdominal Surgery, Postoperative Complications, Surgical Apgar Score