Predicting postoperative morbidity in adult elective surgical patients using the Surgical Outcome Risk Tool (SORT)
- 1 July 2017
- journal article
- Published by Elsevier BV in British Journal of Anaesthesia
- Vol. 119 (1), 95-105
- https://doi.org/10.1093/bja/aex117
Abstract
The Surgical Outcome Risk Tool (SORT) is a risk stratification instrument used to predict perioperative mortality. We wanted to evaluate and refine SORT for better prediction of the risk of postoperative morbidity.We analysed prospectively collected data from a single-centre cohort of adult patients undergoing major elective surgery. The data set was split randomly into derivation and validation samples. We used logistic regression to construct a model in the derivation sample to predict postoperative morbidity as defined using the validated Postoperative Morbidity Survey (POMS) assessed at 1 week after surgery. Performance of this 'SORT-morbidity' model was then tested in the validation sample and compared against the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM).The SORT-morbidity model was constructed using a derivation sample of 1056 patients and validated in a further 527 patients. SORT-morbidity was well calibrated in the validation sample, as assessed using calibration plots and the Hosmer-Lemeshow test (χ 2 =4.87, P =0.77). It showed acceptable discrimination by receiver operating characteristic curve analysis [area under the receiver operating characteristic curve (AUROC)=0.72, 95% confidence interval: 0.67-0.77]. This compared favourably with POSSUM (AUROC=0.66, 95% confidence interval: 0.60-0.71), whilst being simpler to use. Linear shrinkage factors were estimated, which allow the SORT-morbidity model to predict a range of alternative morbidity outcomes with greater accuracy, including low- and high-grade morbidity, and POMS at later time points.SORT-morbidity can be used before surgery, with clinical judgement, to predict postoperative morbidity risk in major elective surgery.Keywords
This publication has 25 references indexed in Scilit:
- Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statisticsBMJ, 2013
- The Clavien-Dindo Classification of Surgical ComplicationsAnnals of Surgery, 2009
- Classification of Surgical ComplicationsAnnals of Surgery, 2004
- The surgical risk scale as an improved tool for risk-adjusted analysis in comparative surgical auditBritish Journal of Surgery, 2002
- The Use of a Postoperative Morbidity Survey to Evaluate Patients with Prolonged Hospitalization After Routine, Moderate-Risk, Elective SurgeryAnesthesia & Analgesia, 1999
- Statistical Comparison of Two ROC-curve Estimates Obtained from Partially-paired DatasetsMedical Decision Making, 1998
- POSSUM: A scoring system for surgical auditBritish Journal of Surgery, 1991
- Measuring the Accuracy of Diagnostic SystemsScience, 1988
- Estimating the Dimension of a ModelThe Annals of Statistics, 1978
- A new look at the statistical model identificationIEEE Transactions on Automatic Control, 1974