The assessment of surgical apgar scores in adult patients with TB of the spine undergoing major spine surgery

Abstract

Background: Tuberculosis (TB) is an age old disease, dating back to the time of Hippocrates. In the spine, it most commonly affects the thoracic spine, followed by the thoracolumbar junction, lumbar spine and cervical spine. The management is largely medical, with surgery reserved for only the intractable and severe forms. Surgery is fraught with formidable complications, which has sparked an interest in a tool to predict those patients who are likely to do poorly, thus increase clinician vigilance. Methodology: Our study aimed to assess the correlation of the surgical Apgar score as set out by Gawande et al. in patients undergoing surgery for TB of the spine. It is a retrospective study of patients’ records who underwent surgery between 2010 and 2015 at Chris Hani Baragwanath (CHBAH) and Charlotte Maxeke Johannesburg Academic (CMJAH) Hospitals. Results: We reviewed the records of 33 patients, and we found 15 patients with a score of 0-/= 4, 10 of them had complications, while five had none. Of the 10 patients with a score of 5-6, only two developed complications. Additionally, none of the eight patients with a score of 7-8 developed any complications. There was a statistically significant negative correlation between low Surgical Apgar Score (SAS) and the development of complications. Conclusion: We concluded that in a subset of spine patients undergoing surgery for TB, a low SAS could be predictive for the development of complications. There was no correlation with the level of the spine affected, the patient’s age or their underlying comorbidities.