Analysis of surgical apgar score combined with ASA classification (SASA) score in ICU and non-ICU patients following intra-abdominal surgery
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Kulsiri Bumrungchatudom 1 , Rebecca Chavez 2 , Weeratian Tawanwongsri 3 4 , Siwatus Puangrab 5 *
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1 Department of Anesthesiology, Bamrasnaradura Infectious Diseases Institute, Nonthaburi, THAILAND2 Department of Emergency Medicine, Southwest Consortium, Temecula, CA, USA3 Division of Dermatology, Department of Internal Medicine, School of Medicine, Walailak University, Nakhon Si Thammarat, THAILAND4 Center of Excellence in Data Science for Health Study, Walailak University, Nakhon Si Thammarat, THAILAND5 Division of Pain, Department of Anesthesiology, School of Medicine, Walailak University, Nakhon Si Thammarat, THAILAND* Corresponding Author

Abstract

Background: Identifying high-risk patients for intensive care unit (ICU) admission after intra-abdominal surgery is crucial, especially in resource-limited settings. This study evaluates the predictive accuracy of the surgical apgar score combined with ASA classification (SASA) for ICU admission within 48 hours.
Methods: A retrospective cohort of 242 patients (24 ICU admissions, 9.9%) was analyzed, with a mean age of 58.25 years (standard deviation = 15.41) and 137 males (56.6%). The performance of SAS and SASA was assessed using ROC curve and calibration analysis.
Results: SASA outperformed SAS (area under the receiver operating characteristic [auROC]: 0.9483 vs. 0.8772). An optimal SASA cutoff score of 13 provided 83.33% sensitivity and 94.95% specificity for ICU admission. ASA classification, open abdominal surgery, operative duration, hemodynamic instability, and blood loss were significant ICU predictors (p < 0.001).
Conclusion: SASA demonstrates superior predictive accuracy for ICU admission and enhances perioperative risk stratification. Prospective studies are recommended to validate its role in predicting morbidity and mortality.

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article Type: Original Article

ELECTRON J GEN MED, Volume 22, Issue 5, October 2025, Article No: em675

https://doi.org/10.29333/ejgm/16621

Publication date: 01 Sep 2025

Online publication date: 16 Jul 2025

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