Development and validation of the Surgical Outcome Risk Tool (SORT)

Abstract

BackgroundExisting risk stratification tools have limitations and clinical experience suggests they are not used routinely. The aim of this study was to develop and validate a preoperative risk stratification tool to predict 30-day mortality after non-cardiac surgery in adults by analysis of data from the observational National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Knowing the Risk study.MethodsThe data set was split into derivation and validation cohorts. Logistic regression was used to construct a model in the derivation cohort to create the Surgical Outcome Risk Tool (SORT), which was tested in the validation cohort.ResultsProspective data for 19 097 cases in 326 hospitals were obtained from the NCEPOD study. Following exclusion of 2309, details of 16 788 patients were analysed (derivation cohort 11 219, validation cohort 5569). A model of 45 risk factors was refined on repeated regression analyses to develop a model comprising six variables: American Society of Anesthesiologists Physical Status (ASA-PS) grade, urgency of surgery (expedited, urgent, immediate), high-risk surgical specialty (gastrointestinal, thoracic, vascular), surgical severity (from minor to complex major), cancer and age 65 years or over. In the validation cohort, the SORT was well calibrated and demonstrated better discrimination than the ASA-PS and Surgical Risk Scale; areas under the receiver operating characteristic (ROC) curve were 0·91 (95 per cent c.i. 0·88 to 0·94), 0·87 (0·84 to 0·91) and 0·88 (0·84 to 0·92) respectively (P < 0·001).ConclusionThe SORT allows rapid and simple data entry of six preoperative variables, and provides a percentage mortality risk for individuals undergoing surgery.

Risk Modeling Predicts Complication Rates for Spinal Surgery

“…A similar modeling approach has been met with success across surgical specialties and within the category of spine surgery. [18][19][20] For instance, a recently developed spinal risk stratification tool, SpineSage (http://depts.washington.edu/ spinersk/), was partly derived from prospective research assessing postoperative SSI risk. 18,20 Therefore, thorough statistical analysis of large surgical registries can inform further studies on perioperative management tailored to patients' specific constellations of risk factors both to manage complications in high-risk patients but also reduce redundant care in low-risk patients.…”

Mortality in Elderly Waiting-List Patients Versus Age-Matched Kidney Transplant Recipients: Where is the Risk?

“…But do we have clinical tools to accurately estimate early mortality in this particular population? Table 2 shows some surgical risk scores frequently used in the general population, which could be applied in elderly waitlisted patients, showing the clinical information necessary for inclusion on the list and, thus, to calculate the risk [73-78]. Although these risk indices are not universally applied in daily clinical transplant practice, efforts should made to apply those indices involving renal impairment, especially when assessing death risk in elderly patients before performing KT.…”

“…However, our Patient B would have a moderate-high risk of early death post-transplantation (Table 3). Finally, the Surgical Outcome Risk Tool (SORT score) includes age, comorbidities and the ASA classification (www.ncepod.org.uk) [78]. Again, our Patient A would have an intermediate and manageable perioperative risk whereas our Patient B would have a high mortality risk.…”

Predictive Risk Modelling for Integrated Care: A Structured Review

“…In addition, there are a number of cost grouping models besides HRG and CMS-HCC, which are more detailed, like Bupa Operative Severity Score [37] and Surgical Outcome Risk Tool [38].…”