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.