Key result
SORT predicts in-hospital mortality after abdominal surgery with ~0.90 AUROC but under-predicts highest-risk deaths.
Why the study?
Assessing post-surgical mortality risk is essential for pre-surgical planning, but the Surgical Outcome Risk Tool (SORT) required external validation in patients undergoing major abdominal surgery.
Does the Surgical Outcome Risk Tool (SORT) accurately predict in-hospital death in patients undergoing major abdominal surgery?
Observational (n=3,305)
Yes
Does the Surgical Outcome Risk Tool (SORT) accurately predict in-hospital death in patients undergoing major abdominal surgery?
The Surgical Outcome Risk Tool (SORT) demonstrated excellent discrimination for predicting in-hospital death in a large cohort of abdominal surgery patients, though some standard-risk patients still experienced adverse outcomes.
SORT supports risk stratification in abdominal surgery; leaves open recalibration needs before clinical adoption.
Background Assessing 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 United Kingdom. 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 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 some patients that were predicted to be standard risk did experience adverse outcomes.
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Oakland et al. (2020) conducted an observational in Major abdominal surgery (n=3,305). Surgical Outcome Risk Tool (SORT) was evaluated on All-cause in-hospital mortality discrimination (AUROC 0.899, 95% CI 0.849 to 0.949). The Surgical Outcome Risk Tool (SORT) accurately discriminated the risk of in-hospital mortality in abdominal surgery patients with an AUROC of 0.899, although it under-predicted deaths in the highest-risk group.
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