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Semin Thorac Cardiovasc Surg. 2019 Autumn;31(3):574-580. doi: 10.1053/j.semtcvs.2018.12.002. Epub 2018 Dec 8.

Esophagectomy Surgical Apgar Score May Not Be Associated With Postoperative Morbidity.

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Department of Anesthesiology, Shizuoka General Hospital, Shizuoka, Japan. Electronic address:
Department of Drug Evaluation and Informatics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan; Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan; Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan.
Department of Anesthesiology, Shizuoka General Hospital, Shizuoka, Japan; Department of Anesthesiology, Seirei Mikatahara General Hospital, Shizuoka, Japan.
Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan.
Department of Anesthesiology, Shizuoka General Hospital, Shizuoka, Japan.


This study was performed to investigate the association between the esophagectomy surgical Apgar score (eSAS) and 30-day morbidity after esophagectomy. We retrospectively identified patients who underwent esophagectomy in our facilities database from January 2011 through December 2015. We calculated the eSAS and modified eSAS, which was adjusted for the blood loss volume, according to our patients' data. After estimating the cut-off point of the eSAS using a receiver operating curve, the morbidity rates between the 2 groups were compared using Fisher's exact test. In addition, logistic regression analysis was performed to adjust the results by factors associated with morbidity. In total, 246 patients were included. Of these patients, 144 presented with major morbidity. The optimal cut-off value of the eSAS was 4 points. A total of 145 patients had an eSAS of <4 points, and 89 of them developed morbidity. A total of 101 patients had an eSAS of ≥4 points, and 55 of them developed morbidity. Fisher's exact test showed that an eSAS of <4 points was not significantly associated with morbidity after esophagectomy (P = 0.29). The association was improved after modification for the blood loss volume (P = 0.004). Multivariable analysis revealed that the modified eSAS and age were significantly associated with morbidity (odds ratio, 0.47 and 1.04, respectively). The validity of the eSAS to predict morbidity after esophagectomy could be low, and the modified blood loss volume may improve the predictive effect.


Esophagectomy; Esophagectomy surgical Apgar score (eSAS); Estimated blood loss; Morbidity

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