The Predictive Power of Intraoperative Surgical Apgar Scores in Foreseeing Renal Function after Radical Nephrectomy.

Abstract

Introduction: This study was conducted to evaluate the predictive power of the Surgical Apgar Score (SAS) based on surgical blood loss, the lowest intraoperative heart rate and mean arterial pressure in foreseeing short- and long-term effects of radical nephrectomy (RN) on renal function.

Methods: A prospective investigation was conducted on 111 patients who underwent RN for kidney tumors at a tertiary hospital between 2016 and 2019. The SAS and age-adjusted Charlson Comorbidity Index (CCI) scores were calculated in relation to glomerular filtration rates (GFR) changes on postoperative 1st day, 3rd and 12th months.

Results: Patients in higher risk groups, stratified on the basis of SAS, had longer operation times, extended hospital stays, increased bleeding, and higher blood transfusion rates (P < .001).No significant difference existed between preoperative and early postoperative GFR values in SAS-stratified risk groups (P = .802, P = .342, respectively). However, a significant GFR decrease occurred in the high-risk group compared to the moderate and low risk groups at postoperative 3rd (60.79 ± 16.86, 76.22 ± 24.20, 69.80 ± 18.92,respectively) and 12th months (53.57 ± 12.74, 71.61 ± 17.52, 71.86 ± 19.33, respectively)(P = .034, P < .001). CCI scores predicted preoperative GFR in low, moderate, and high-risk groups (111.58 ± 30.91 ml/min, 94.81 ± 22.55 ml/min, and 85.43 ± 32.69 ml/min, respectively)(P = .001), but GFR changes between CCI-defined risk groups were not significant at postoperative 3rd and 12th months (P = .546, P = .481).

Conclusion: A significant correlation was found between SAS estimated during the RN procedure and GFR changes at three and twelve months after surgery. Based on SAS, early kidney-preserving therapies like diet, and avoidance of nephrotoxic agents may be recommended for high-risk patients to prevent prolonged GFR alterations.