Emergency General Surgery LaparotomySAS-ICUNCT07814131
Surgical Apgar Score for Identifying Patients Who May Need Intensive Care After Emergency Abdominal Surgery
An observational study of Emergency General Surgery Laparotomy, run by King Edward Medical University at 1 site in Pakistan.
Trial summary
This prospective observational study will evaluate whether the Surgical Apgar Score can help identify patients who require direct admission to the intensive care unit after emergency abdominal surgery. Read more about this study
- Who is it for?
- Ages 13 to 89 years
- Conditions the study is for
- Emergency General Surgery Laparotomy
- How many people
- 77 participants
- Where
- 1 sitePakistan
- Study dates
- 24 Aug 2026to 24 Nov 2026
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 13 to 89 years
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Study population: Patients presenting to Mayo Hospital Lahore who undergo emergency exploratory laparotomy for emergency general surgery pathology will be enrolled consecutively. Eligible participants will include males and females aged 13-89 years undergoing emergency laparotomy within 8 hours of surgical evaluation. The study population will include patients undergoing laparotomy for conditions such as gastrointestinal perforation, intestinal obstruction, intra-abdominal sepsis, ischemia, and blunt or penetrating abdominal trauma. The Surgical Apgar Score will be calculated immediately after surgery using estimated blood loss, lowest intraoperative mean arterial pressure, and lowest intraoperative heart rate. Patients will subsequently be classified according to direct postoperative ICU admission.
Who may be able to join
- Male and female patients aged 13 to 89 years. Patients undergoing emergency exploratory laparotomy at Mayo Hospital Lahore for an emergency general surgery indication.
- Patients undergoing laparotomy within 8 hours of surgical evaluation. Patients with emergency general surgery pathologies including gastrointestinal perforation, intestinal obstruction, ischemia, intra-abdominal sepsis, and blunt or penetrating abdominal trauma.
- Patients who provide informed consent for participation.
Who cannot join
- Patients transferred from another emergency institution when more than 8 hours have elapsed since initial presentation.
- Patients who do not undergo emergency exploratory laparotomy. Patients who do not have sufficient intraoperative data to calculate the Surgical Apgar Score.
- Patients for whom postoperative disposition to ICU or another postoperative location cannot be determined.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site
Mayo Hospital Lahore
Lahore, Punjab Province, 54000
dr zeeshan sarwar, MBBS, FCPS, +923075275080, mzeeshansarwar@gmail.com
dr zeeshan sarwar, MBBS, FCPS, mzeeshansarwar@gmail.com
About this study
Official title: Surgical Apgar Score Predicts ICU Admission After Emergency General Surgery Laparotomy
This prospective observational study will evaluate whether the Surgical Apgar Score can help identify patients who require direct admission to the intensive care unit after emergency abdominal surgery. The study will include patients aged over 12 and under 90 years undergoing emergency exploratory laparotomy at Mayo Hospital Lahore. The Surgical Apgar Score will be calculated immediately after surgery using three routinely recorded intraoperative factors: estimated blood loss, lowest mean arterial pressure, and lowest heart rate. Patients will be categorized into low Surgical Apgar Score (≤7) and high Surgical Apgar Score (>7) groups. The frequency of direct intensive care unit admission will be compared between the two groups to determine whether a low Surgical Apgar Score is associated with increased need for postoperative intensive care.
Read the detailed description
Emergency general surgery laparotomy is associated with a substantial risk of postoperative complications and may require postoperative intensive care. In resource-limited healthcare settings, appropriate identification of patients who are likely to require intensive care may assist in postoperative triage and rational allocation of limited critical care resources.
The Surgical Apgar Score (SAS) is a simple 10-point perioperative risk score calculated using three intraoperative parameters: estimated blood loss, lowest mean arterial pressure, and lowest heart rate. Lower scores have been associated with increased postoperative morbidity and mortality in several surgical populations. Previous studies have also reported an association between low SAS and direct postoperative intensive care unit admission. However, evidence regarding its utility among patients undergoing emergency general surgery laparotomy in the local setting is limited.
This study will prospectively observe patients undergoing emergency exploratory laparotomy at Mayo Hospital Lahore and evaluate the relationship between the Surgical Apgar Score and direct postoperative intensive care unit admission. The score will be calculated immediately after surgery using routinely documented intraoperative parameters. Patients will subsequently be categorized according to their SAS, with scores of 7 or less classified as low and scores greater than 7 classified as high.
The study will determine the frequency of direct intensive care unit admission and assess whether patients with a low Surgical Apgar Score are more likely to require direct postoperative intensive care than those with a higher score. Relevant demographic and clinical characteristics will also be recorded to allow assessment of factors that may influence the relationship between SAS and intensive care admission.
The findings may help determine whether the Surgical Apgar Score can serve as a simple and readily available tool for identifying emergency laparotomy patients at increased risk of requiring postoperative intensive care. This may support more objective postoperative triage and resource allocation in high-volume, resource-constrained surgical settings.
- Conditions
- Emergency General Surgery Laparotomy
- Keywords
- Surgical Apgar Score, Emergency General Surgery, Emergency Laparotomy, Exploratory Laparotomy, Intensive Care Unit Admission, Postoperative ICU Admission, Surgical Risk Assessment
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Low Surgical Apgar Score (≤7) | Participants undergoing emergency exploratory laparotomy who have a Surgical Apgar Score of ≤7, calculated immediately after surgery from estimated blood loss, lowest mean arterial pressure, and lowest heart rate recorded during the operation. This cohort will be observed for direct admission to the intensive care unit following surgery. No intervention is assigned as part of the study. | |
| High Surgical Apgar Score (>7) | Participants undergoing emergency exploratory laparotomy who have a Surgical Apgar Score of >7, calculated immediately after surgery from estimated blood loss, lowest mean arterial pressure, and lowest heart rate recorded during the operation. This cohort will be observed for direct admission to the intensive care unit following surgery. No intervention is assigned as part of the study. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Direct Postoperative Intensive Care Unit Admission
The proportion of patients transferred directly from the operating room to the Intensive Care Unit immediately following emergency exploratory laparotomy.
Measured: Within 1 hour after completion of surgery
Secondary outcomes (1)
Association of Surgical Apgar Score category with direct postoperative ICU admission
The proportion of patients with a low Surgical Apgar Score (≤7) will be compared with patients with a high Surgical Apgar Score (>7) to determine the association between SAS category and direct admission to the intensive care unit following emergency general surgery laparotomy.
Measured: Perioperative/Periprocedural
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted10 Sep 2026
- Study start24 Aug 2026 (estimated)
- Primary completion24 Nov 2026 (estimated)
- Study completion24 Nov 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Emergency General Surgery LaparotomyStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 77 participants (estimated)
Sponsor and investigators
- Lead sponsor
- King Edward Medical University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- dr zeeshan sarwar, Principal investigator, King Edward Medical University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07814131
- Sponsor's protocol ID
- 2023-7628
- Acronym
- SAS-ICU
- Status last verified
- Sep 2026
- First submitted
- 28 Aug 2026
- Last updated
- 10 Sep 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: Individual participant data will not be shared with other researchers because the study involves patient-level clinical data collected for the purposes of this research, and no data-sharing plan has been established. Data will be securely maintained by the research team in accordance with institutional and ethical requirements.
Publications
Tracy BM, Srinivas S, Baselice H, Gelbard RB, Coleman JR. Surgical Apgar scores predict complications after emergency general surgery laparotomy. J Trauma Acute Care Surg. 2024 Mar 1;96(3):429-433. doi: 10.1097/TA.0000000000004189. Epub 2023 Nov 8.
PubMed 37936276Lin YC, Chen YC, Yang CH, Su NY. Surgical Apgar score is strongly associated with postoperative ICU admission. Sci Rep. 2021 Jan 8;11(1):115. doi: 10.1038/s41598-020-80393-z.
PubMed 33420227Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ. An Apgar score for surgery. J Am Coll Surg. 2007 Feb;204(2):201-8. doi: 10.1016/j.jamcollsurg.2006.11.011. Epub 2006 Dec 27.
PubMed 17254923
Study at a glance
From the registry record, last updated by the sponsor on 10 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Surgical Apgar Score Predicts ICU Admission After Emergency General Surgery Laparotomy
- ClinicalTrials.gov ID
- NCT07814131
- Acronym / sponsor ID
- SAS-ICU / 2023-7628
- Conditions
- Emergency General Surgery Laparotomy
- Keywords
- Surgical Apgar Score, Emergency General Surgery, Emergency Laparotomy, Exploratory Laparotomy, Intensive Care Unit Admission, Postoperative ICU Admission, Surgical Risk Assessment
- Study type
- Observational
- Recruitment status
- Not yet recruiting
- Enrolment
- 77 participants (estimated)
- Lead sponsor
- King Edward Medical UniversityUniversity, hospital or other
- Study start
- 24 Aug 2026 (estimated)
- Primary completion
- 24 Nov 2026 (estimated)
- Study completion
- 24 Nov 2026 (estimated)
- First posted
- 10 Sep 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This prospective observational study will evaluate whether the Surgical Apgar Score can help identify patients who require direct admission to the intensive care unit after emergency abdominal surgery. The study will include patients aged over 12 and under 90 years undergoing emergency exploratory laparotomy at Mayo Hospital Lahore. The Surgical Apgar Score will be calculated immediately after surgery using three routinely recorded intraoperative factors: estimated blood loss, lowest mean arterial pressure, and lowest heart rate. Patients will be categorized into low Surgical Apgar Score (≤7) and high Surgical Apgar Score (>7) groups. The frequency of direct intensive care unit admission will be compared between the two groups to determine whether a low Surgical Apgar Score is associated with increased need for postoperative intensive care.
Detailed description
Emergency general surgery laparotomy is associated with a substantial risk of postoperative complications and may require postoperative intensive care. In resource-limited healthcare settings, appropriate identification of patients who are likely to require intensive care may assist in postoperative triage and rational allocation of limited critical care resources.
The Surgical Apgar Score (SAS) is a simple 10-point perioperative risk score calculated using three intraoperative parameters: estimated blood loss, lowest mean arterial pressure, and lowest heart rate. Lower scores have been associated with increased postoperative morbidity and mortality in several surgical populations. Previous studies have also reported an association between low SAS and direct postoperative intensive care unit admission. However, evidence regarding its utility among patients undergoing emergency general surgery laparotomy in the local setting is limited.
This study will prospectively observe patients undergoing emergency exploratory laparotomy at Mayo Hospital Lahore and evaluate the relationship between the Surgical Apgar Score and direct postoperative intensive care unit admission. The score will be calculated immediately after surgery using routinely documented intraoperative parameters. Patients will subsequently be categorized according to their SAS, with scores of 7 or less classified as low and scores greater than 7 classified as high.
The study will determine the frequency of direct intensive care unit admission and assess whether patients with a low Surgical Apgar Score are more likely to require direct postoperative intensive care than those with a higher score. Relevant demographic and clinical characteristics will also be recorded to allow assessment of factors that may influence the relationship between SAS and intensive care admission.
The findings may help determine whether the Surgical Apgar Score can serve as a simple and readily available tool for identifying emergency laparotomy patients at increased risk of requiring postoperative intensive care. This may support more objective postoperative triage and resource allocation in high-volume, resource-constrained surgical settings.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Low Surgical Apgar Score (≤7) | – | –Participants undergoing emergency exploratory laparotomy who have a Surgical Apgar Score of ≤7, calculated immediately after surgery from estimated blood loss, lowest mean arterial pressure, and lowest heart rate recorded during the operation. This cohort will be observed for direct admission to the intensive care unit following surgery. No intervention is assigned as part of the study. |
| High Surgical Apgar Score (>7) | – | –Participants undergoing emergency exploratory laparotomy who have a Surgical Apgar Score of >7, calculated immediately after surgery from estimated blood loss, lowest mean arterial pressure, and lowest heart rate recorded during the operation. This cohort will be observed for direct admission to the intensive care unit following surgery. No intervention is assigned as part of the study. |
Who may qualify
- Ages
- 13 to 89 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
- Study population
- Patients presenting to Mayo Hospital Lahore who undergo emergency exploratory laparotomy for emergency general surgery pathology will be enrolled consecutively. Eligible participants will include males and females aged 13-89 years undergoing emergency laparotomy within 8 hours of surgical evaluation. The study population will include patients undergoing laparotomy for conditions such as gastrointestinal perforation, intestinal obstruction, intra-abdominal sepsis, ischemia, and blunt or penetrating abdominal trauma. The Surgical Apgar Score will be calculated immediately after surgery using estimated blood loss, lowest intraoperative mean arterial pressure, and lowest intraoperative heart rate. Patients will subsequently be classified according to direct postoperative ICU admission.
Key inclusion criteria (3 listed)
- Male and female patients aged 13 to 89 years. Patients undergoing emergency exploratory laparotomy at Mayo Hospital Lahore for an emergency general surgery indication.
- Patients undergoing laparotomy within 8 hours of surgical evaluation. Patients with emergency general surgery pathologies including gastrointestinal perforation, intestinal obstruction, ischemia, intra-abdominal sepsis, and blunt or penetrating abdominal trauma.
- Patients who provide informed consent for participation.
Key exclusion criteria (3 listed)
- Patients transferred from another emergency institution when more than 8 hours have elapsed since initial presentation.
- Patients who do not undergo emergency exploratory laparotomy. Patients who do not have sufficient intraoperative data to calculate the Surgical Apgar Score.
- Patients for whom postoperative disposition to ICU or another postoperative location cannot be determined.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Direct Postoperative Intensive Care Unit Admission
Time frame: Within 1 hour after completion of surgery
The proportion of patients transferred directly from the operating room to the Intensive Care Unit immediately following emergency exploratory laparotomy.
1 secondary outcome
Association of Surgical Apgar Score category with direct postoperative ICU admission
Time frame: Perioperative/Periprocedural
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Sep 2026.
- Background: PubMed 37936276Tracy BM, Srinivas S, Baselice H, Gelbard RB, Coleman JR. Surgical Apgar scores predict complications after emergency general surgery laparotomy. J Trauma Acute Care Surg. 2024 Mar 1;96(3):429-433. doi: 10.1097/TA.0000000000004189. Epub 2023 Nov 8.
- Background: PubMed 33420227Lin YC, Chen YC, Yang CH, Su NY. Surgical Apgar score is strongly associated with postoperative ICU admission. Sci Rep. 2021 Jan 8;11(1):115. doi: 10.1038/s41598-020-80393-z.
- Background: PubMed 17254923Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ. An Apgar score for surgery. J Am Coll Surg. 2007 Feb;204(2):201-8. doi: 10.1016/j.jamcollsurg.2006.11.011. Epub 2006 Dec 27.
- Individual participant dataSharing planned: No. Individual participant data will not be shared with other researchers because the study involves patient-level clinical data collected for the purposes of this research, and no data-sharing plan has been established. Data will be securely maintained by the research team in accordance with institutional and ethical requirements.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
dr zeeshan sarwar principal investigator
King Edward Medical University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Emergency General Surgery Laparotomy, run by King Edward Medical University at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 10 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Mahnoor Dr Wasim, MBBS, MRCSEd, CHPE (+923075275080, mahnoorwsm@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Direct Postoperative Intensive Care Unit Admission (time frame: Within 1 hour after completion of surgery). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07814131, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Sep 2026.