Predictive role of surgical Apgar score for postoperative complications and survival in patients receiving esophagectomy: a meta-analysis

Abstract Purpose The association between surgical Apgar score (SAS) and clinical outcomes among patients undergoing esophagectomy remains uncertain now. This study aimed to further identify the predictive role of SAS for postoperative complications and survival in patients receiving esophagectomy. Method PubMed, EMbase and Web of Science databases were searched up to March 27, 2025. Primary endpoints included the postoperative overall complication (OC) and overall survival (OS) and secondary endpoints consists of specific complications and disease-free survival (DFS). Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were combined to assess the predictive value of SAS for complications and survival, respectively. Results Ten studies with 2453 patients were included. Pooled results demonstrated that SAS was significantly related to the risk of overall complications (OR = 0.43, 95% CI: 0.33–0.57, P<0.001), but not associated with OS (HR = 0.84, P = 0.246). Furthermore, a low SAS predicted increased risk of anastomotic leakage (OR = 0.44, P = 0.004), chylothorax (OR = 0.33, P = 0.020), infection (OR = 0.43, P<0.001), 30-day mortality (OR = 0.40, P = 0.011), pneumonia (OR = 0.61, P = 0.037), reintubation (OR = 0.29, P = 0.003), respiratory complication (OR = 0.49, P = 0.014), gastrointestinal complication (OR = 0.57, P = 0.035), length of stay (OR = 0.60, P = 0.038), pulmonary complication (OR = 0.46, P = 0.003). However, SAS was not associated with the risk of other complications such as the cardiac complication (P = 0.215) and sepsis (P = 0.087) and DFS (P = 0.341) in esophageal cancer patients. Conclusion SAS may serve as novel prognostic indicator for postoperative complications in patients receiving esophagectomy and low SAS predicts increased risk for complications. However, more studies are needed to further verify above findings.