Key result
The Surgical Outcome Risk Tool (SORT) demonstrated good discriminative ability for predicting in-hospital mortality with an AUROC of 0.899, though it underpredicted deaths in the highest-risk group.
Why the study?
Assessing post-surgical mortality risk is a key component of pre-surgical planning, and the study aimed to externally validate the Surgical Outcome Risk Tool (SORT) in patients undergoing major abdominal surgery.
Does the Surgical Outcome Risk Tool (SORT) accurately predict in-hospital mortality in patients undergoing major abdominal surgery?
Observational (n=3,305)
Yes
Does the Surgical Outcome Risk Tool (SORT) accurately predict in-hospital mortality in patients undergoing major abdominal surgery?
SORT demonstrated good discrimination for predicting in-hospital mortality in abdominal surgery patients, though it underpredicted adverse outcomes in the highest-risk group.
Low perioperative mortality does not yet guide ICU triage decisions; leaves open prospective validation of risk-stratified monitoring.
BACKGROUND: Assessing the risk of post-surgical mortality is a key component of pre-surgical planning. The Surgical Outcome Risk Tool (SORT) uses pre-operative variables to predict 30-day mortality. The aim of this study was to externally validate SORT in patients undergoing major abdominal surgery. METHODS: Data were collected from patients treated in five independent hospitals in the UK. Individualised SORT scores were calculated, and area under the receiver operating characteristic (AUROC) and precision-recall curves (PRC) plus 95% confidence intervals (CI) were drawn to test the ability of SORT to identify in-hospital death. Outcomes of patients with a SORT predicted risk of mortality of ≥ 5% (high risk) were compared to those with a predicted risk of < 5% (standard risk). RESULTS: The study population comprised 3305 patients, mean age 51 years, 2783 (84.2%) underwent elective surgery most frequently involving the colon (24.6%), or liver, pancreas or gallbladder (18.2%). Overall, 1551 (46.9%) patients were admitted to ICU and 29 (0.88%) died. The AUROC of SORT for discriminating patients at risk of death in hospital was 0.899 (95% CI 0.849 to 0.949) and the PRC 0.247. In total, 72 (2.18%) patients were stratified as high risk. There were more unplanned ICU admissions and deaths in this group compared to the standard risk group (25.0% and 3.3%, versus 3.1% and 0.5%, respectively). CONCLUSION: We externally validated SORT in a large population of abdominal surgery patients. SORT performed well in patients with lower risk profiles, but underpredicted adverse outcomes in the higher risk group.
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Oakland et al. (2021) conducted an observational in Major abdominal surgery (n=3,305). Surgical Outcome Risk Tool (SORT) was evaluated on In-hospital mortality (AUROC 0.899, 95% CI 0.849 to 0.949). The Surgical Outcome Risk Tool (SORT) demonstrated good discriminative ability for predicting in-hospital mortality with an AUROC of 0.899, though it underpredicted deaths in the highest-risk group.
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