2014 SSAT POSTER PRESENTATION The Surgical Apgar Score Predicts Postoperative ICU Admission Nina E. Glass & Antonio Pinna & Antonio Masi & Alan S. Rosman & Dena Neihaus & Shunpei Okochi & John K. Saunders & Ioannis Hatzaras & Steven Cohen & Russell Berman & Elliot Newman & H. Leon Pachter & Thomas H. Gouge & Marcovalerio Melis Received: 6 June 2014 /Accepted: 15 December 2014 # 2015 The Society for Surgery of the Alimentary Tract Keywords Risk assessment . Scoring systems . Surgery . Surgical Apgar score Background In the past, many scoring systems have been developed with a goal of predicting perioperative outcomes, including American Society of Anesthesiologists (ASA) class, Physiologic and Operative Severity Score for the Enumeration [sic] of Mortality and Morbidity (POSSUM), Surgical Risk Score, Biochemistry and Haematology Outcome Models, Acute Physiology and Chronic Health Evaluation (APACHE), Cleveland Clinic Foundation Colorectal Cancer Model, the French Association of Surgery’ s colorectal scale, and the National Surgical Quality Improvement Program (NSQIP) mortality predictor. 1–5 However, most of these systems are complicated, proprietary, limited (either to preoperative risk or to a single measurement of physiologic variables), and tend to be difficult to implement in the everyday care of patients. For example, the ASA is primarily a frailty index that is simple and widely known but is limited by significant inter-user variability since it does not depend on objective criteria and it does not factor in the patients physiologic condition during the course of their operation. 2 POSSUM uses 12 physiological variables and 6 intraoperative variables to create a score, and because of overprediction of risk in low-risk patients, it has been modified in many ways to try to improve prediction. APACHE and its more recent modifications is a complex and proprietary scoring system that is therefore difficult to use at the bedside. Postoperative triage to the appropriate level of care may improve outcomes of surgical patients and optimize use of available hospital capabilities. 1,12 However, to date, clinicians lack a simple objective system to optimize postoperative ad- mission to the ICU while avoiding over triage and overutiliza- tion of expensive and scarce resources. In this context, the surgical Apgar score (SAS) was developed as a 10-point scor- ing system easily calculated with limited intraoperative data (blood loss, lowest mean arterial pressure, lowest heart rate during general anesthesia) that predicts postoperative morbidity and mortality. 6 In the last few years, the SAS has been validated in several settings and surgical subspecialties. 7–11 This study aims to investigate the correlation of the SAS with ICU admis- sion after general surgery procedures. Methods Data Collection For participation in the Veterans Health Administration Surgical Quality Improvement Program (VASQIP), a prospective This research was presented and awarded an SSAT Poster of Distinction at Digestive Disease Week, May 4, 2014, Chicago, IL, USA. N. E. Glass : A. Pinna : A. Masi : D. Neihaus : S. Okochi : J. K. Saunders : I. Hatzaras : S. Cohen : R. Berman : E. Newman : H. L. Pachter : T. H. Gouge : M. Melis (*) Department of Surgery, New York Harbor Healthcare System, 423 E 23RD St # 4153 N, New York, NY 10044, USA e-mail: marcovalerio.melis@nyumc.org N. E. Glass : A. Pinna : A. Masi : J. K. Saunders : I. Hatzaras : S. Cohen : R. Berman : E. Newman : H. L. Pachter : T. H. Gouge : M. Melis Department of Surgery, NYU School of Medicine, Brooklyn, NY, USA A. Pinna University of Sassari, Sassari, Italy A. S. Rosman Section of Gastroenterology and Medicine Program, Mount Sinai School of Medicine and James J. Peters VAMC, New York, NY, USA J Gastrointest Surg DOI 10.1007/s11605-014-2733-8