Background

The 2011 NCEPOD study on perioperative care ("Knowing the Risk")1 looked at risk and outcome in patients undergoing inpatient surgery. 19,097 case report forms were prospectively collected from 326 National Health Service (NHS) hospitals in England, Wales, and Northern Ireland, public hospitals in Isle of Man, Guernsey and Jersey, and independent sector hospitals. Principal recommendations in the report from this study, included a need for a way to rapidly and easily identify high risk patients, and that a preoperative mortality risk assessment should made explicit to the patient and recorded on the consent form.

A variety of methods are available for clinicians to help predict risk of adverse outcomes (including death) after surgery, including assessments of functional capacity (e.g. cardiopulmonary exercise testing), and risk stratification tools such as the P-POSSUM, the Surgical Risk Scale, and the American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator. In 2013 a qualitative systematic review of risk stratification tools for predicting morbidity and mortality was published2. The P-POSSUM and Surgical Risk Scale were found to be the most reliable risk stratification tools based on published data, but both were noted to have limitations.

In response to the "Knowing the Risk" recommendations, data from 16,788 patients included in that study were used to develop and internally validate the Surgical Outcome Risk Tool (SORT). It allows rapid and simple data entry of six preoperative variables, and provides a percentage mortality risk estimate for patients who are undergoing non-cardiac, non-neurological inpatient surgery. The scientific methods used to develop the SORT are detailed in a manuscript published by the British Journal of Surgery in 2014. At the time of publication, this work represented the largest analysis of risk prediction tools in a UK cohort of patients undergoing inpatient surgery in multiple surgical specialties.

You can access the manuscript3 here: BJS and Wiley.



It should be noted that no risk prediction tool is completely accurate, and there is always a chance that patients deemed to be low risk will develop complications or die after surgery, or that predicted high risk patients will do well. Further work to externally validate the SORT and other risk stratification tools is required, and the authors of the SORT manuscript would welcome approaches from potential collaborators for future validation work. Please see the Contact tab for further details.

References
  • Findlay GP, Goodwin APL, Protopapa KL, Smith NCE, Mason M. Knowing the Risk: a Review of the Peri-Operative Care of Surgical Patients. National Confidential Enquiry into Patient Outcome and Death; London, 2011.
  • Moonesinghe SR, Mythen MG, Das P, Rowan KM, Grocott MPW. Risk stratification tools for predicting morbidity and mortality in adult patients undergoing major surgery: qualitative systematic review. Anesthesiology 2013; 119: 959–981.
  • Protopapa KL, Simpson JC, Smith NCE, Moonesinghe SR. Development and validation of the Surgical Outcome Risk Tool (SORT). Br J Surg 2014. 101: 1774-1783.
    Available here: BJS and Wiley.