Low surgical Apgar score in older patients with gynecological cancer is a risk factor for postoperative complications and 1‑year mortality: A multicenter retrospective cohort study

Yamamoto,Makoto; Kurata,Kazumi; Asai‑Sato,Mikiko; Shiomi,Mayu; Ueda,Yutaka; Aoki,Yoichi; Yoshida,Yoshio

doi:10.3892/mco.2020.2183

Low surgical Apgar score in older patients with gynecological cancer is a risk factor for postoperative complications and 1‑year mortality: A multicenter retrospective cohort study

Authors:
- Makoto Yamamoto
- Kazumi Kurata
- Mikiko Asai‑Sato
- Mayu Shiomi
- Yutaka Ueda
- Yoichi Aoki
- Yoshio Yoshida
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Affiliations: Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui 910‑1193, Japan, Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Kanagawa 236‑0004, Japan, Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka 565‑0871, Japan, Department of Obstetrics and Gynecology, Graduate School of Medicine, University of The Ryukyus, Okinawa 903‑0215, Japan
Published online on: November 27, 2020 https://doi.org/10.3892/mco.2020.2183
Article Number: 21
Copyright: © Yamamoto et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Little is known about preoperative and intraoperative risk factors for postoperative complications in older patients with gynecological cancer. The present retrospective multi‑institutional study included 173 older patients with primary gynecological cancer between January 2015 and December 2015 at four institutions. The cancer stage, medical history, Charlson comorbidity score, body mass index (BMI), subjective global assessment, fall risk assessment, American Society of Anesthesiologists physical status classification, surgical Apgar score (SAS), type of surgery and 1‑year postoperative mortality were investigated. Multivariate analysis revealed that BMI and mental illness were risk factors for postoperative complications, and low SAS increased the risk for both postoperative complications and mortality within 1 year. Receiver operating characteristic curve analysis of postoperative complications in terms of SAS revealed that low SAS predicted high risk with a sensitivity of 85.7% and a specificity of 46.5%, and high SAS predicted low risk with a sensitivity of 21.4% and a specificity of 95%. The present results suggest that SAS, which is an intraoperative assessment, may be useful for assessing the risks of postoperative complications and mortality within 1 year. It is important to develop a preoperative assessment tool that can predict a low SAS score and reflect the postoperative prognosis of older patients with gynecological cancer.

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