Predictability of surgical apgar score on short term outcomes of laparotomies at the university teaching hospital in Lusaka, Zambia

Abstract

The Surgical Apgar Score (SAS) is a very easy and objective tool for triaging patients postsurgery. It can be used as an assessment tool for performance of hospitals, units or individual surgeons. However, not much research has been done to assess its utility in resource limited settings like Zambia. This study was undertaken to assess the predictability of SAS in laparotomy patients at UTH in Lusaka, Zambia.This was a prospective cohort study. A total of 50 patients were recruited, their intraoperative data collected and SAS calculated. The patients were followed up for 30 days. The primary end point was incidence of any major complication and/or death as defined by the Dindo-Clavien classification. Two out of the 50 patients enrolled were lost to follow up, leaving a total of 48 patients. Age ranged from 17 to 89 years with mean age of 38.8 years (SD 17 years). Out of the patients enrolled, 79 percent were male with 73 percent of operations being emergencies. Intestinal obstruction was the most common diagnosis accounting for 31.3 percent followed by viscus perforation. Of the patients enrolled, 58.3 percent had no complications. Overall, complications rate was 41.3 percent which was consistent with published literature. Deep surgical site infection was the most common complications at 12.5 percent. Patients who did not develop complications had a significantly higher SAS compared to patients who did (p<0.001). Mortality rate in the high risk group was higher than predicted by SAS (p=0.23). Period of operation and gender did not significantly affect the SAS of patients (p values =0.45 and 0.28 respectively). This study confirms that SAS is adequate at predicting outcome in laparotomy patients in resource limited settings like UTH. Key words; laparotomy, postoperative complications, Surgical Apgar score