Department of Surgical Sciences, Anaesthesiology and Intensive Care, Akademiska Sjukhuset, Uppsala, Sweden.
Department of Clinical Science, Intervention, and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Br J Surg. 2023 Apr 12;110(5):584-590. doi: 10.1093/bjs/znad039.
The Surgical Outcome Risk Tool (SORT) was derived and validated in the UK to improve preoperative prediction of postoperative risk. The aim of this study was to validate the SORT in a European mixed-case surgical population outside of the UK.
The study included patients aged at least 18 years with ASA Physical Status (ASA-PS) grades I-V who underwent non-cardiac surgery at four tertiary hospitals in Sweden between November 2015 and February 2016. Exclusion criteria were surgery under local anaesthesia and missing data on the SORT predictors (ASA-PS, surgical urgency, high-risk surgery, surgical severity, malignancy, age over 65 years). The outcome was 30-day mortality. Discrimination and calibration of the SORT were assessed using area under the receiver operating curve (AUROC) statistics and calibration plots. A sensitivity analysis was done in a high-risk subgroup (ASA-PS III or higher; surgical complexity major to Xmajor according to the SORT; gastrointestinal, orthopaedic, urogenital/obstetric surgery; and age at least 18 years).
The validation cohort included 17 965 patients; median age was 58 (i.q.r. 40-70) years, 43.2 per cent were men, and the mortality rate at 30 days was 1.6 per cent. The SORT had excellent discrimination, with an AUROC of 0.91 (95 per cent c.i. 0.89 to 0.92), and good calibration. The high-risk subgroup (1807 patients) had a 30-day mortality rate of 5.6 per cent; in the sensitivity analysis, the SORT had good discrimination, with an AUROC of 0.79 (0.74 to 0.83), and calibration remained good.
The estimates of the original the SORT for prediction of 30-day mortality were valid and reliable in a mixed-case surgical population in a non-UK European setting.
外科手术结局风险工具（SORT）是在英国开发并验证的，旨在改善术后风险的术前预测。本研究的目的是在英国以外的欧洲混合病例外科人群中验证 SORT。
该研究纳入了 2015 年 11 月至 2016 年 2 月期间在瑞典四家三级医院接受非心脏手术且年龄至少 18 岁的 ASA 身体状况（ASA-PS）分级 I-V 级患者。排除标准为局部麻醉下手术和 SORT 预测因子（ASA-PS、手术紧迫性、高危手术、手术严重程度、恶性肿瘤、年龄超过 65 岁）缺失。主要结局为 30 天死亡率。采用接受者操作特征曲线（AUROC）下面积统计量和校准图评估 SORT 的区分度和校准度。在高危亚组（ASA-PS III 或更高；SORT 定义的手术复杂性为主要至 X 主要；胃肠道、骨科、泌尿生殖/产科手术；年龄至少 18 岁）中进行敏感性分析。
验证队列纳入 17965 例患者；中位年龄为 58（四分位距 40-70）岁，43.2%为男性，30 天死亡率为 1.6%。SORT 具有优异的区分度，AUROC 为 0.91（95%可信区间 0.89 至 0.92），且校准良好。高危亚组（1807 例）30 天死亡率为 5.6%；在敏感性分析中，SORT 具有良好的区分度，AUROC 为 0.79（0.74 至 0.83），校准仍然良好。
在英国以外的欧洲混合病例外科人群中，SORT 预测 30 天死亡率的原始估计值是有效且可靠的。
