BETHESDA, MD USA (UroToday.com) - Introduction/Objective: Tailoring of perioperative management to minimize postoperative complication rates depends on reliable prognostication of those patients most at risk. The Surgical Apgar Score (SAS) is an objective measure of the operative course based on EBL, lowest heart rate and mean arterial pressure. It has been validated to predict major complications and death following general/vascular surgery, where a lower SAS is associated with increasing rates of adverse post-operative events. We aimed to assess the ability of the SAS and Nephrometry Score (NS) to identify the cohort of patients most likely to benefit from more intensive postoperative care algorithms.
Materials and Methods: Data for 886 patients undergoing renal mass excision via radical or partial nephrectomy from 2010-2013 was extracted from a prospectively collected database at a single institution. SAS was calculated utilizing electronic anesthesia records. NS was calculated for each patient via review of preoperative imaging. Major postoperative complications examined included cardiac events, significant leak/hemorrhage, and any readmission or re-operation within 30 days of surgery and 90-day mortality.
Results: 13.3% of patients experienced major postoperative complications. Clavien grade I, II, III, IV and V complications were experienced by 27%, 6%, 48%, 9% and 10% respectively. The 90-day mortality rate was 1.4%. SAS was significantly lower (mean 7.3 vs 7.8, p=0.004) and NS was significantly higher (8.8 vs 8.0, p=0.0001) in patients experiencing major postoperative complications. Patients experiencing major complications also were significantly older (mean 62 vs 59yo, p=0.009), and more likely to have undergone open surgery (55% vs 32%, p<0.0001). SAS was also significantly lower in patients dying within 90 days of surgery (6.3 vs 7.7, p=0.03). Patients with complex renal lesions (NS 10-12) experiencing a low SAS ≤ 4 were 8.2 times more likely to experience a major complication (p=0.0008) and 16 times more likely to die within 90 days of surgery (p=0.003) than patients with simple renal lesions (NS 4-6) experiencing a SAS ≥ 8.
Conclusion: SAS and NS are simply collected metrics that can identify patients at a higher risk for major complication and death following renal mass excision. A prospective trial to help to further delineate optimal utilization of both tools in an adjusted perioperative management approach with patients undergoing complex renal mass excision is warranted.
Presented by:
Timothy Ito,1 Philip Abbosh,1 Reza Mehrazin,1 Jeffrey Tomaszewski,1 Serge Ginzburg,2 Daniel Canter,2 Tianyu Li,1 Richard Greenberg,1 Rosalia Viterbo,1 David Chen,1 Alexander Kutikov,1 Marc Smaldone,1 and Robert Uzzo1
1Fox Chase Cancer Center, Philadelphia, PA; 2Einstein Healthcare Network, Philadelphia, PA
Presented at the 2014 Winter Meeting of the Society of Urologic Oncology (SUO) "Defining Excellence in Urologic Oncology" - December 3 - 5, 2014 - Bethesda, MD USA