Objective: To evaluate whether the Surgical Apgar Score (SAS) can identify patients who are at risk for perioperative adverse events (PAE) following radical prostatectomy for prostate cancer. Patients and Methods: At a single academic institution, 994 patients undergoing radical prostatectomy between 2010 and 2013 were analyzed retrospectively. The SAS was calculated from anesthesia records, evaluated to predict PAE within a 30-day time period postoperatively; these events were classified according to standardized classification systems. Results: We observed adverse events in 45.4% (451/994) of patients with a total of 694 events. Overall, 41% (408/994) had low- and 9.9% (98/994) had high-grade events. A lower SAS was identified as an independent predictor of any (p < 0.001) and low-grade adverse events (p = 0.001) for those patients who had undergone open retropubic radical prostatectomy (ORRP). Each 1-point increment resulted in a 24% decrease in the odds of any (95% CI 0.66-0.88) and a 21% decrease in the odds of a low-grade (95% CI 0.69-0.91) event. Adverse events of robot-assisted prostatectomy were not associated with the SAS. Conclusions: Lower SAS values indicate patients at risk for adverse events after ORRP. The SAS might serve as one variable for outcome assessment, reflecting the challenge of mutual surgical and anesthesiology procedure management.

Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213.
Niklas C, Saar M, Berg B, Steiner K, Janssen M, Siemer S, et al: da Vinci and open radical prostatectomy: comparison of clinical outcomes and analysis of insurance costs. Urol Int 2016;96:287-294.
Löppenberg B, Noldus J, Holz A, Palisaar RJ: Reporting complications after open radical retropubic prostatectomy using the martin criteria. J Urol 2010;184:944-948.
Musch M, Klevecka V, Roggenbuck U, Kroepfl D: Complications of Pelvic Lymphadenectomy in 1,380 Patients Undergoing Radical Retropubic Prostatectomy Between 1993 and 2006. J Urol 2008;179:923-928; discussion 928-929.
Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ: An Apgar score for surgery. J Am Coll Surg 2007;204:201-208.
Regenbogen SE, Ehrenfeld JM, Lipsitz SR, Greenberg CC, Hutter MM, Gawande AA: Utility of the surgical Apgar score: validation in 4119 patients. Arch Surg 2009;144:30-36; discussion 37.
Ito T, Abbosh PH, Mehrazin R, Tomaszewski JJ, Li T, Ginzburg S, et al: Surgical Apgar score predicts an increased risk of major complications and death after renal mass excision. J Urol 2015;193:1918-1922.
Prasad SM, Ferreria M, Berry AM, Lipsitz SR, Richie JP, Gawande AA, et al: Surgical Apgar outcome score: perioperative risk assessment for radical cystectomy. J Urol 2009;181:1046-1052; discussion 1052-1053.
Satava RM: Identification and reduction of surgical error using simulation. Minim Invasive Ther Allied Technol 2005;14:257-261.
Menon M, Shrivastava A, Kaul S, Badani KK, Fumo M, Bhandari M, et al: Vattikuti institute prostatectomy: contemporary technique and analysis of results. Eur Urol 2007;51:648-657; discussion 657-658.
Budäus L, Isbarn H, Schlomm T, Heinzer H, Haese A, Steuber T, et al: Current technique of open intrafascial nerve-sparing retropubic prostatectomy. Eur Urol 2009;56:317-324.
Khuri SF, Daley J, Henderson W, Hur K, Demakis J, Aust JB, et al: The Department of Veterans Affairs' NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg 1998;228:491-507.
Roghmann F, Trinh QD, Braun K, von Bodman C, Brock M, Noldus J, et al: Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy. Int J Urol 2014;21:143-149.
Reynolds PQ, Sanders NW, Schildcrout JS, Mercaldo ND, St Jacques PJ: Expansion of the surgical Apgar score across all surgical subspecialties as a means to predict postoperative mortality. Anesthesiology 2011;114:1305-1312.
Urrutia J, Valdes M, Zamora T, Canessa V, Briceno J: An assessment of the surgical Apgar score in spine surgery. Spine J 2015;15:105-109.
Rabbani F, Yunis LH, Pinochet R, Nogueira L, Vora KC, Eastham JA, et al: Comprehensive standardized report of complications of retropubic and laparoscopic radical prostatectomy. Eur Urol 2010;57:371-386.
Novara G, Ficarra V, Rosen RC, Artibani W, Costello A, Eastham JA, et al: Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol 2012;62:431-452.
Ohlsson H, Winsö O: Assessment of the Surgical Apgar Score in a Swedish setting. Acta Anaesthesiol Scand 2011;55:524-529.
Lestar M, Gunnarsson L, Lagerstrand L, Wiklund P, Odeberg-Wernerman S: Hemodynamic perturbations during robot-assisted laparoscopic radical prostatectomy in 45° Trendelenburg position. Anesth Analg 2011;113:1069-1075.
Doherty M, Buggy DJ: Intraoperative fluids: how much is too much? Br J Anaesth 2012;109:69-79.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.