In this study we aimed to define a new modified SAS is to predict the incidence of postoperative complication and mortality in major abdominal and orthopedic surgery. We also identify the effectivity of this modified scoring system composed of the duration of operation in addition to the three intraoperative parameters of SAS.

Inclusion Criteria:

• Subject has major surgery
• More than 18 years

Exclusion Criteria:

• Pregnant
• Younger than 18

Patients who underwent elective major surgery (Abdominal and Orthopedic surgery) were included (n=308)

After the operation modified SAS (mSAS) was calculated by adding the duration of the operation to data used in calculation of the SAS (Table 1.).

Observed complications and related conditions were also noted.

Table 1. Modified Surgical Apgar Score (mSAS)

mSAS 0 1 2 3 4

Estimated blood loss, ml >1000 601-1000 101-600 ≤100 -

Lowest MAP*, mmHg <40 40-54 55-69 ≥70 -

Lowest HR**, beats per min >85 76-85 66-75 56-65 ≤55

Time -4 -3 -2 -1 0

Duration of operation (hour) >8 7.01-8 5.01-7 3.01-5 0-3

* MAP=Mean arterial pressure