Predictive Accuracy of the Surgical Apgar Score for Outcomes After Emergency Surgery at Yirol Hospital South Sudan: A Retrospective One Year Observational Study

Introduction: Emergency surgery at Yirol Hospital appears to constitute a critical component of the local healthcare infrastructure, serving a patient population frequently presenting with life-threatening pathologies that require urgent intervention. The present study seeks to validate the predictive performance of the Surgical Apgar Score in identifying postoperative morbidity and mortality secondary to emergency within the specific patient population at Yirol Hospital. Methodology: This study employs a retrospective observational study design, analyzing data from patients who underwent emergency surgical procedures at Yirol Hospital over a 12-month period, covering 1 May 2025 to 1 May 2026 and encompassing a diverse cohort presenting with acute trauma and life-threatening surgical emergencies. Eligibility was restricted to adult patients who underwent non-elective operations during the designated time-frame; patients with incomplete intraoperative physiological records were excluded. The primary outcome is the incidence of surgical site infection, with mortality within 30 days as the secondary outcome. To evaluate the scoring system's predictive accuracy, receiver operating characteristic curves will be constructed for both major morbidity and mortality. Results: The area under the receiver operating characteristic curve was calculated as 0.67 with confidence interval 95% (0.40-.94) and a p-value of 0.22 (Handley McNeil) statistically significant. Conclusion: The Surgical Apgar Score demonstrates a modest trend toward identifying patients at risk for postoperative morbidity at Yirol Hospital, yet it currently lacks the statistical precision required for robust clinical triage.