Validation of the Surgical Outcome Risk Tool (SORT) and SORT v2 for Predicting Postoperative Mortality in Patients with Pancreatic Cancer Undergoing Surgery

Abstract

Background: Pancreatic cancer surgery is related to significant mortality, thus necessitating the accurate assessment of perioperative risk to enhance treatment decision making. A Surgical Outcome Risk Tool (SORT) and SORT v2 have been developed to provide enhanced risk stratification. Our aim was to validate the accuracy of SORT and SORT v2 in pancreatic cancer surgery. Method: Two hundred and twelve patients were included and underwent pancreatic surgery for cancer. The surgeries were performed by a single surgical team in a single tertiary hospital (2016–2022). We assessed a total of four risk models: SORT, SORT v2, POSSUM (Physiology and Operative Severity Score for the enumeration of Mortality and Morbidity), and P-POSSUM (Portsmouth-POSSUM). The accuracy of the model was evaluated using an observed-to-expected (O:E) ratio and the area under the curve (AUC). Results: The 30-day mortality rate was 3.3% (7 patients). Both SORT and SORT v2 demonstrated excellent discrimination traits (AUC: 0.98 and AUC: 0.98, respectively) and provided the best-performing calibration in the total analysis. However, both tools underestimated the 30-day mortality. Furthermore, both reported a high level of calibration and discrimination in the subgroup of patients undergoing pancreaticoduodenectomy, with previous ERCP, and CA19-9 ≥ 500 U/mL. Conclusions: SORT and SORT v2 are efficient risk-assessment tools that should be adopted in the perioperative pathway, shared decision-making (SDM) process, and counseling of patients with pancreatic cancer undergoing surgery.

Outcomes of Patients Undergoing Elective Pancreatic Surgery During COVID-19 Pandemic: A Multicenter, Prospective Cohort Study

“…Therefore, the recommended optimal interval for pancreatic surgery after infection in our study is 4 weeks, different from the recent consensus, which suggests a recommended timing of 7 weeks, 8 based on a baseline validated risk assessment tool. 26 Our conclusions are derived from a prospective observational cohort study focusing on pancreatic surgery rather than overall surgery. In addition, our study was conducted during a different phase of the pandemic, when most of the enrolled patients may have been infected with a less toxic variant of Omicron and thus, had milder symptoms.…”

Validation of Perioperative Troponin Levels for Predicting Postoperative Mortality and Long-Term Survival in Patients Undergoing Surgery for Hepatobiliary and Pancreatic Cancer

“…It can address the current limitations in available platforms and ensure that the complexity and specific considerations of HPB surgeries are adequately reflected in the assessment, potentially leading to more accurate cost evaluation and resource allocation. According to a recent study from our team [6], the SORT has demonstrated excellent discrimination (area under the curve: 0.98) and calibration traits in predicting 30-day mortality regarding patients undergoing pancreatic surgery.…”

Surgery and Reason: The End of History and the Last Surgeon

“…Based on increasing evidence favoring the use of multiple arterial conduits in patients undergoing CABG [11], a "Hegelian" circle, based on the superiority of the MAG approach, is about to close, and a new one is about to open, which will examine different strategies in conduits harvesting, treatment protocols on the extent of target vessel stenosis for radial artery conduits, along with post-discharge treatment protocols. The present Special Issue includes several articles that aim to answer important debates on different perioperative treatment pathways [12][13][14][15][16][17][18]. Two of them [14,15] validate risk-stratification tools, thus providing a necessary insight into preoperative planning and patient counseling while enhancing the shared decision-making process.…”

“…Dr. Richard Prager is a characteristic world-historical individual in the field of QI in cardiothoracic surgery. From the very beginning of his efforts to establish a QI program in the State of Michigan, Dr. Prager faced certain great challenges, such as a) gathering all cardiothoracic surgeons of the State around a common table to discuss their outcomes and designing QI initiatives, The present Special Issue includes several articles that aim to answer important debates on different perioperative treatment pathways [12][13][14][15][16][17][18]. Two of them [14,15] validate risk-stratification tools, thus providing a necessary insight into preoperative planning and patient counseling while enhancing the shared decision-making process.…”

“…From the very beginning of his efforts to establish a QI program in the State of Michigan, Dr. Prager faced certain great challenges, such as a) gathering all cardiothoracic surgeons of the State around a common table to discuss their outcomes and designing QI initiatives, The present Special Issue includes several articles that aim to answer important debates on different perioperative treatment pathways [12][13][14][15][16][17][18]. Two of them [14,15] validate risk-stratification tools, thus providing a necessary insight into preoperative planning and patient counseling while enhancing the shared decision-making process. In addition, Giardini et al [12] compare two techniques in performing the supine-to-sitting postural change in patients with sternotomy, while Frisiras et al [16] compare morbidity and mortality outcomes in elderly and nonelderly patients undergoing elective thoracic endovascular aortic repair (TEVAR).…”