Surgical Apgar score (Gawande)

Surgical Apgar

Compute the Gawande 2007 intraoperative Surgical Apgar score from estimated blood loss, lowest mean arterial pressure, and lowest heart rate.

LIVE $0.005 USDC GET /api/calc/surgical_apgar

Markdown: /docs/surgical-apgar.md · Canonical: https://magentlab.com/docs/surgical-apgar

Not a medical device. Not a diagnosis, dose, or listing recommendation.

What it computes

Compute the Gawande 2007 intraoperative Surgical Apgar score from estimated blood loss, lowest mean arterial pressure, and lowest heart rate.

When to use

When an agent needs the published intraoperative Surgical Apgar total and must not substitute Virginia Apgar or treat the score as operative clearance.

When not to use

Not a medical device and not an operative-clearance, cancellation, or monitoring order. magent does not observe the operation.
This is the Gawande 2007 intraoperative Surgical Apgar (Table 1) only. It is not the Virginia Apgar newborn score.
Estimated blood loss, lowest MAP, and lowest heart rate are caller-supplied intraoperative values. magent does not read an anesthesia record.
score_le_4 follows the validation-cohort association of scores ≤4 with 58.6% 30-day death or major complication (9–10 with 3.6%). It is not an operative-clearance decision.

Formula

Surgical Apgar = ebl_points + lowest_map_points + lowest_hr_points; Gawande 2007 Table 1; max 10

Citation

Title: An Apgar score for surgery
Authors: Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ
Source: J Am Coll Surg. 2007;204(2):201-208
DOI: 10.1016/j.jamcollsurg.2006.11.011

Worked example

EBL 50 mL, lowest MAP 80, lowest HR 60

Given: ebl_ml=50lowest_heart_rate_bpm=60lowest_map_mm_hg=80

EBL 50 → 3; lowest MAP 80 → 3; lowest HR 60 → 3
Score = 9 (max 10); score_le_4 = false

EBL 1500 mL, lowest MAP 35, lowest HR 90

Given: ebl_ml=1500lowest_heart_rate_bpm=90lowest_map_mm_hg=35

EBL 1500 → 0; lowest MAP 35 → 0; lowest HR 90 → 0
Score = 0 (max 10); score_le_4 = true

Also searched as

surgical apgar
gawande
intraoperative
surgical apgar score
Gawande Apgar
intraoperative apgar
SAS surgery

Try

Opens the live endpoint. Unpaid browser requests show the paywall; agents should send Accept: application/json.

/api/calc/surgical_apgar?ebl_ml=50&lowest_map_mm_hg=80&lowest_heart_rate_bpm=60

Full URL: https://api.magentlab.com/api/calc/surgical_apgar?ebl_ml=50&lowest_map_mm_hg=80&lowest_heart_rate_bpm=60

Call

Expect HTTP 402 until you retry with PAYMENT-SIGNATURE. Incomplete query params return HTTP 400 before any quote or charge.

curl -i -H "Accept: application/json" "https://api.magentlab.com/api/calc/surgical_apgar?ebl_ml=50&lowest_map_mm_hg=80&lowest_heart_rate_bpm=60"

Parameters

Name	Type	Required	Description
`ebl_ml`	number	required	Estimated intraoperative blood loss in mL (0.0-20000.0). Gawande 2007 Table 1: >1000 → 0, 601-1000 → 1, 101-600 → 2, ≤100 → 3.
`lowest_map_mm_hg`	number	required	Lowest intraoperative mean arterial pressure in mm Hg (30.0-180.0). Gawande 2007 Table 1: <40 → 0, 40-54 → 1, 55-69 → 2, ≥70 → 3.
`lowest_heart_rate_bpm`	integer	required	Lowest intraoperative heart rate in beats/min (integer 30-220). Gawande 2007 Table 1: >85 → 0, 76-85 → 1, 66-75 → 2, 56-65 → 3, ≤55 → 4.

Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

POST /api/calc/surgical_apgar Max 25 unit_amount + extra_item_amount * (n - 1) extra $0.002 PREVIEW

1 to 25 items. Each item uses the same keys as the GET query parameters.
POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request (fixture)

{
  "items": [
    {
      "ebl_ml": "50",
      "lowest_heart_rate_bpm": "60",
      "lowest_map_mm_hg": "80"
    },
    {
      "ebl_ml": "50",
      "lowest_heart_rate_bpm": "60",
      "lowest_map_mm_hg": "80"
    }
  ]
}

Open bulk paywall →

Opens a two-item fixture on the API host. Unpaid browsers get the same MetaMask paywall as GET; Pay retries POST with those items.

Example 200 (fixture)

{
  "count": 2,
  "path": "/api/calc/surgical_apgar",
  "items": [
    {
      "components": [
        {
          "value": 50.0,
          "factor": "ebl_ml",
          "points": 3,
          "present": true
        },
        {
          "value": 80.0,
          "factor": "lowest_map_mm_hg",
          "points": 3,
          "present": true
        },
        {
          "value": 60,
          "factor": "lowest_heart_rate_bpm",
          "points": 3,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ",
        "doi": "10.1016/j.jamcollsurg.2006.11.011",
        "id": "gawande-2007",
        "pmid": "17254927",
        "source": "J Am Coll Surg. 2007;204(2):201-208",
        "title": "An Apgar score for surgery"
      },
      "formula": "surgical_apgar",
      "formula_expression": "Surgical Apgar = ebl_points + lowest_map_points + lowest_hr_points; Gawande 2007 Table 1; max 10",
      "max_score": 10,
      "score": 9,
      "ebl_ml": 50.0,
      "lowest_heart_rate_bpm": 60,
      "lowest_map_mm_hg": 80.0,
      "score_le_4": false
    },
    {
      "components": [
        {
          "value": 50.0,
          "factor": "ebl_ml",
          "points": 3,
          "present": true
        },
        {
          "value": 80.0,
          "factor": "lowest_map_mm_hg",
          "points": 3,
          "present": true
        },
        {
          "value": 60,
          "factor": "lowest_heart_rate_bpm",
          "points": 3,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ",
        "doi": "10.1016/j.jamcollsurg.2006.11.011",
        "id": "gawande-2007",
        "pmid": "17254927",
        "source": "J Am Coll Surg. 2007;204(2):201-208",
        "title": "An Apgar score for surgery"
      },
      "formula": "surgical_apgar",
      "formula_expression": "Surgical Apgar = ebl_points + lowest_map_points + lowest_hr_points; Gawande 2007 Table 1; max 10",
      "max_score": 10,
      "score": 9,
      "ebl_ml": 50.0,
      "lowest_heart_rate_bpm": 60,
      "lowest_map_mm_hg": 80.0,
      "score_le_4": false
    }
  ]
}

Response

Field	Type	Description
`formula`	string	surgical_apgar
`formula_expression`	string	Exact expression used
`score`	integer	Surgical Apgar points 0-10
`max_score`	integer	Always 10
`score_le_4`	boolean	true when score is ≤4. Gawande 2007 validation cohort associated scores ≤4 with 58.6% 30-day death or major complication, and scores 9-10 with 3.6%. Not an operative-clearance decision.
`ebl_ml`	number	Estimated blood loss used, mL
`lowest_map_mm_hg`	number	Lowest intraoperative MAP used, mm Hg
`lowest_heart_rate_bpm`	integer	Lowest intraoperative heart rate used, bpm
`components`	array	Per-factor points
`citation`	object	Gawande 2007 J Am Coll Surg citation
`disclaimer`	string	Not-a-device notice

Example JSON

Machine form of the same example. Frozen fixture. Not a live lookup.

{
  "components": [
    {
      "value": 50.0,
      "factor": "ebl_ml",
      "points": 3,
      "present": true
    },
    {
      "value": 80.0,
      "factor": "lowest_map_mm_hg",
      "points": 3,
      "present": true
    },
    {
      "value": 60,
      "factor": "lowest_heart_rate_bpm",
      "points": 3,
      "present": true
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ",
    "doi": "10.1016/j.jamcollsurg.2006.11.011",
    "id": "gawande-2007",
    "pmid": "17254927",
    "source": "J Am Coll Surg. 2007;204(2):201-208",
    "title": "An Apgar score for surgery"
  },
  "formula": "surgical_apgar",
  "formula_expression": "Surgical Apgar = ebl_points + lowest_map_points + lowest_hr_points; Gawande 2007 Table 1; max 10",
  "max_score": 10,
  "score": 9,
  "ebl_ml": 50.0,
  "lowest_heart_rate_bpm": 60,
  "lowest_map_mm_hg": 80.0,
  "score_le_4": false
}

Client errors (HTTP 400)

Invalid params return 400 without charge. Shared HTTP 402 and 503 meanings: Payments.

HTTP	Code	When
400	`invalid_ebl_ml`	ebl_ml must be a number from 0 to 20000. Returned before settlement; you are not charged.
400	`invalid_map_mm_hg`	map_mm_hg must be a number from 30 to 180. Returned before settlement; you are not charged.
400	`invalid_heart_rate`	heart_rate_bpm must be an integer from 30 to 220 Returned before settlement; you are not charged.
400	`invalid_items`	POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
400	`invalid_item_count`	items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
400	`invalid_item`	each items entry must be a JSON object Returned before settlement; you are not charged.

Related tools

Apgar score — Compute the Apgar newborn evaluation score as the sum of five caller-assigned 0-2 signs.
RCRI — Sum the six Lee 1999 revised cardiac risk index factors and return class I–IV.
MAP — Compute conventional estimated mean arterial pressure from cuff systolic and diastolic pressures.

Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. Unpaid valid requests return HTTP 402 with a base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote: retry the same PAYMENT-SIGNATURE. Full handshake and shared payment errors: Payments. Stdio MCP: /docs/mcp.

Guarantees

HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged.
exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
Execution is timeout-bounded and concurrency-capped.
Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.