The Utility of the Surgical Apgar Score in Assessing the Risk of Perioperative Complications Following Spinal Fusion Surgery for Pediatric Patients with Scoliosis and Cerebral Palsy

Kensuke Shinohara; Tracey P Bryan; Carrie E Bartley; Michael P Kelly; Vidyadhar V Upasani; Peter O Newton

doi:10.1097/BRS.0000000000005098

The Utility of the Surgical Apgar Score in Assessing the Risk of Perioperative Complications Following Spinal Fusion Surgery for Pediatric Patients with Scoliosis and Cerebral Palsy

Spine (Phila Pa 1976). 2024 Jul 17. doi: 10.1097/BRS.0000000000005098. Online ahead of print.

Authors

Kensuke Shinohara¹, Tracey P Bryan², Carrie E Bartley², Michael P Kelly^{2

3}, Vidyadhar V Upasani^{2

3}, Peter O Newton^{2

3}

Affiliations

¹ Department of Orthopaedics Surgery, Okayama University Hospital, Okayama City, Okayama, Japan.
² Division of Orthopedics & Scoliosis, Rady Children's Hospital, 3020 Children's Way, San Diego, CA, USA.
³ Department of Orthopaedics, University of California, San Diego, CA, USA.

PMID: 39016387
DOI: 10.1097/BRS.0000000000005098

Abstract

Study design: Cohort study.

Objective: Validate the Surgical Apgar Score (SAS) as a means of predicting perioperative major complications occurring within 30 days after scoliosis surgery in pediatric patients with cerebral palsy (CP).

Summary of background data: A patient's SAS, which is composed of three commonly recorded intraoperative variables, predicts postoperative complications after various types of spine surgery. This has not; however, been studied in pediatric patients with scoliosis and CP, a population that experiences a high incidence of complications after corrective spinal surgery.

Methods: Pediatric CP patients who underwent spinal correction surgery were included in this study. Patient background, surgical variables, and perioperative complications occurring within 30 days after surgery were collected. Patients were divided into 4 groups based on their SAS: SAS 0-4, SAS 5-6, SAS 7-8, SAS 9-10. The incidences of perioperative complications for each group were compared using a receiver operating characteristic analysis. Area under curve (AUC) is reported.

Results: A total of 111 patients met the inclusion criteria. There were no death cases. There were 44 (39.6%) perioperative major complications in 37 (33.3%) patients that occurred within 30 days after spine surgery. The most frequent perioperative complications were pulmonary issues (13.5%). The incidence of perioperative major complication in each SAS group was as follows: SAS 0-4; 51.6%, SAS 5-6; 30.2%, SAS 7-8; 18.5%, SAS 9-10; 0/0. When the SAS 7-8 group was set as the reference, there was no significant difference compared to SAS 5-6 (P=0.34), while the incidence rate was significantly increased in SAS 0-4 (P=0.02). The AUC was 0.65 (95% Confidence Interval: 0.54-0.75).

Conclusions: Overall, there were 37 (33.3%) patients with CP who had a major complication within 30 days after spinal surgery. Lower SAS, with the 0-4 group being the cutoff, were associated with significantly higher complication rates than higher SAS groups.