Value of modified surgical Apgar score in predicting postoperative complications of hilar cholangiocarcinoma

Objective To investigate the value of modified surgical Apgar score( m SAS) in predicting the postoperative complications of hilar cholangiocarcinoma. Methods A retrospective analysis was performed for the clinical data of 188 patients who underwent surgery due to hilar cholangiocarcinoma in Shengjing Hospital of China Medical University from April 2013 to September 2019,and the patients were divided into complication group with 125 patients and non-complication group with 63 patients. The two groups were compared in terms of related clinical data,including sex,age,carcinoembryonic antigen,carbohydrate antigen 19-9,Bismuth-Corlett type,preoperative jaundice,albumin,surgical Apgar score,and surgical approach. The nonparametric Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups,and the chi-square test was used for comparison of categorical data between two groups. A logistic regression model was used for multivariate analysis,and the receiver operating characteristic( ROC) curve was plotted. Results Of all 188 patients,125( 66. 5%) experienced complications after surgery. There was a significant difference in m SAS between the complication group and the non-complication group( χ2= 65. 685,P < 0. 001),and the patients with high m SAS had an incidence rate of postoperative complications of 40. 6%,while those with low m SAS had an incidence rate of 96. 6%. The analysis of each complication showed that there was a significant difference between the high m SAS and low m SAS patients with bacteremia,pulmonary infection,abdominal infection,incision complications,intraperitoneal hemorrhage,and liver failure( χ2= 15. 196,52. 245,48. 409,5. 556,11. 087,and 17. 772,all P <0. 05). The multivariate regression analysis showed that m SAS( odds ratio [OR]= 0. 026,95% confidence interval [CI]: 0. 007-0. 099,P < 0. 001),surgical procedure( OR = 2. 195,95% CI: 1. 070-4. 500,P = 0. 032),and severity of preoperative jaundice( OR = 2. 479,95% CI: 1. 376-4. 434,P = 0. 002) were independent influencing factors for complications after surgery for hilar cholangiocarcinoma. The m SAS had an area under the ROC curve( AUC) of 0. 830( 95% CI: 0. 768-0. 880) in predicting complications after surgery for hilar cholangiocarcinoma,while SAS had an AUC of 0. 776( 95% CI: 0. 710-0. 834). At the optimal cut-off value of 6. 5,m SAS had a sensitivity of 96. 6%,a specificity of 59. 4%,and an accuracy of 76. 6%. Conclusion The m SAS can help to predict the postoperative complications of hilar cholangiocarcinoma.