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Surgical Outcome Score of Gawande et al (Surgical Apgar Score)

Purpose: To evaluate a patient who has undergone general or vascular surgery using the outcome score of Gawande et al.

Description

Gawande et al developed a 10-point score for predicting surgical outcomes following general or vascular surgery. This can help identify patients who are at greatest risk for complications, and it is described by the authors as a "surgical Apgar score." The authors are from Harvard University, Brigham and Women's Hospital and Massachusetts General Hospital in Boston.


Parameters:

(1) estimated blood loss

(2) lowest mean arterial blood pressure in mm Hg during the procedure

(3) lowest heart rate in beats per minute during the procedure

 

mean arterial pressure in mm Hg =

= ((systolic blood pressure) + (2 * (diastolic blood pressure))) / 3

 

Parameter

Finding

Points

estimated blood loss

<= 100 mL

3

 

101 - 600 mL

2

 

601 - 1,000 mL

1

 

> 1,000 mL

0

lowest mean arterial blood pressure

>= 70 mm Hg

3

 

55 - 69 mm Hg

2

 

40 - 54 mm Hg

1

 

<= 39 mm Hg

0

lowest heart rate

<= 55 beats per minute, nonpathologic

4

 

56 - 65 beats per minute

3

 

66 - 75 beats per minute

2

 

76 - 85 beats per minute

1

 

> 85 beats per minute

0

 

pathologic bradyarrhythmia

0

 

where:

• Pathologic bradyarrhythmia includes (a) sinus arrest,(b)  atrioventricular block or dissociation, (c) junctional or ventricular escape rhythms or (d) asystole.

 

total score =

= SUM(points for all 3 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 10

• The higher the score the better the survival.

 

Total Score

Major Complications or Death within 30 Days of General or Vascular Surgery

9 or 10

3.6% (0% mortality)

7 or 8

6.4%(< 1% mortality)

5 or 6

16% (5% mortality)

0 to 4

59% (14% mortality)

from Figure 1, page 207


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Specialty

Objective

ICD-10