Janowak et al evaluated patients undergoing esophagectomy and identified risk factors associated with short-term complications. These can help to identify patients who may require more aggressive management. The authors are from the University of Wisconsin.
Patient selection: esophagectomy for malignancy
Outcome: 30-day major morbidity which included
(1) bleeding requiring at least 4 units of packed red blood cells within 72 hours of operation
(2) cardiac arrest requiring cardiopulmonary resuscitation
(3) myocardial infarction
(4) deep venous thrombosis
(5) pulmonary embolism
(6) coma for at least 24 hours
(7) stroke
(8) acute renal failure
(9) wound disruption
(10) deep or organ-space surgical site infection (including anastomotic leak)
(11) systemic inflammatory response syndrome, sepsis, or septic shock
(12) pneumonia
(13) unplanned intubation
(14) ventilator use for at least 48 hours
(15) Clavien class III complications (requiring surgical, endoscopic, or radiologic intervention)
(16) Clavien class IV (requiring readmission to the ICU or considered life threatening)
Risk factors for major morbidity within 30 days of esophagectomy:
(1) esophagectomy Surgical Apgar score (eSAS) <= 6
(2) transhiatal approach (versus transthoracic)
(3) body mass index < 20 or > 35 kg per square meter
(4) diabetes mellitus
(5) ASA class III or IV
Parameters for the esophagectomy SAS are the same as for the original Surgical Apgar Score:
(1) estimated blood loss in mL
(2) lowest mean arterial pressure in mm Hg
(3) lowest heart rate in beats per minute
|
Parameter
|
Finding
|
Points
|
|
estimated blood loss
|
> 300 mL
|
0
|
|
|
201 to 200 mL
|
1
|
|
|
151 to 200 mL
|
2
|
|
|
<= 150 mL
|
3
|
|
lowest MAP
|
< 40 mm Hg
|
0
|
|
|
40 to 54 mm Hg
|
1
|
|
|
55 to 69 mm Hg
|
2
|
|
|
>= 70 mm Hg
|
3
|
|
lowest heart rate
|
> 85 beats per minute
|
0
|
|
|
76 to 85
|
1
|
|
|
66 to 75
|
2
|
|
|
56 to 65
|
3
|
|
|
<= 55 beats per minute
|
4
|
where:
• The primary difference from the original Surgical Apgar Score is in point assignment for estimated blood loss.
total eSAS =
= SUM(points for all 3 parameters)
Interpretation:
• minimum eSAS: 0
• maximum eSAS: 10
• The higher the eSAS the better.
