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Predicting Postoperative Morbidity in Adult Elective Surgical Patients using the Surgical Outcome Risk Tool (SORT)

Wong, DJN; Oliver, CM; Moonesinghe, SR; (2017) Predicting Postoperative Morbidity in Adult Elective Surgical Patients using the Surgical Outcome Risk Tool (SORT). British Journal of Anaesthesia , 119 (1) pp. 95-105. 10.1093/bja/aex117. Green open access

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Abstract

Background: The Surgical Outcome Risk Tool (SORT) is a risk stratification tool that predicts perioperative mortality. We construct a new recalibrated model based on SORT to predict the risk of developing postoperative morbidity. Methods: 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 one 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). Results: The SORT-morbidity model was constructed using a derivation sample of 1056 patients, and validated in 527 patients. SORT-morbidity was well-calibrated in the validation sample, as assessed using calibration plots and the Hosmer-Lemeshow Test (χ² = 4.87, p = 0.77). It showed acceptable discrimination by Receiver Operator Characteristic (ROC) curve analysis (Area Under the ROC curve, AUROC = 0.72, 95% CI 0.67–0.77). This compared favourably with POSSUM (AUROC = 0.66, 95% CI 0.60–0.71), while remaining 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. Conclusions: SORT-morbidity can be used preoperatively, with clinical judgement, to predict postoperative morbidity risk in major elective surgery.

Type: Article
Title: Predicting Postoperative Morbidity in Adult Elective Surgical Patients using the Surgical Outcome Risk Tool (SORT)
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/bja/aex117
Publisher version: https://doi.org/10.1093/bja/aex117
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Morbidity, Risk Assessment, Postoperative Complications
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
URI: https://discovery.ucl.ac.uk/id/eprint/1544971
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