Modified Surgical APGAR Score for Predicting Postoperative Delirium in Emergency Surgery

Patients aged 18 years or older undergoing emergency surgery in any surgical specialty at Istanbul Prof. Dr. Cemil Tascioglu City Hospital were enrolled after written informed consent. Preoperative data (age, sex, ASA physical status, diagnosis, planned operation, surgical specialty, pre-induction Glasgow Coma Scale, and anesthesia technique) were recorded. Intraoperative heart rate and mean arterial pressure were obtained from anesthesia monitor trend data (heart rate at 1-minute intervals; mean arterial pressure at 1-minute intervals with invasive monitoring and 5-minute intervals with non-invasive monitoring). Estimated blood loss was calculated from suction canister contents, irrigation fluids, and blood-soaked gauze/sponges. Operation time was defined as the interval from induction of anesthesia to the end of surgery. The mSAS was calculated for each patient at the end of surgery.

Postoperative delirium and its severity were assessed by the investigator using the CAM-ICU-7 on postoperative days 1, 2, 3, and 5 in both ICU and ward patients, supported by observations of caregivers. The SOFA score was calculated from the worst values in the first 24 postoperative hours. Length of hospital stay, ICU admission and length of ICU stay, and 24th-hour Glasgow Coma Scale were recorded. Patients were followed for 30 days for major complications and mortality using hospital records, clinical notes, and telephone interviews after discharge.

Adults aged 18 years or older undergoing emergency surgery in any surgical specialty, in whom the modified Surgical APGAR Score was calculated at the end of surgery.

Other: Modified Surgical APGAR Score assessment

Calculation of the modified Surgical APGAR Score at the end of surgery using the lowest intraoperative heart rate, lowest mean arterial pressure, estimated blood loss, and operation time. No intervention is applied to the patient.

Time frame: Postoperative days 1, 2, 3, and 5

Presence of postoperative delirium assessed with the Confusion Assessment Method for the Intensive Care Unit-7 (CAM-ICU-7), analyzed according to modified Surgical APGAR Score risk group.

Time frame: Postoperative days 1, 2, 3, and 5

CAM-ICU-7 total score (0-7); higher scores indicate more severe delirium.

Time frame: Within 30 days after surgery

Includes ICU admission, unplanned intubation, mechanical ventilation within 48 hours, unplanned reoperation, blood transfusion, surgical site infection, new-onset arrhythmia, myocardial infarction, pneumonia, sepsis/septic shock, bacteremia, acute kidney injury, pulmonary embolism, deep vein thrombosis, postoperative inotrope/vasopressor requirement, and cardiac arrest requiring CPR.

Time frame: Within 30 days after surgery

Death from any cause.

Time frame: Within 30 days after surgery

Number of postoperative days in hospital.

Time frame: Up to 30 days after surgery

Number of days in the intensive care unit.

Time frame: Up to 30 days after surgery

Number of days on mechanical ventilation.

Time frame: First 24 hours after surgery

Sequential Organ Failure Assessment score calculated from the worst values in the first 24 postoperative hours.

Use of the Modified Surgical APGAR Score for Predicting Postoperative Delirium in Adult Patients Undergoing Emergency Surgery: A Prospective Observational Cohort Study