Post-operative Mortality Risk

This can be useful to calculate risks associated with the procedure in order to guide discussions or help determine the post-operative destination that is recommended for patients.

Criteria for screening

Patients who are undergoing Major+/Complex procedures and who have METS < 4 for any reason (as determined by the Duke Activity Status Index) should have their Surgical Outcome Risk calculated using the following tool.

The tool can also be found by directly searching for ‘Surgical Outcome Risk Tool v2 (SORT)’ found at www.sortsurgery.com.

The SORT model

The SORT uses some information about patient health and the planned surgical procedure to provide an estimate of the risk of death within 30 days of an operation. The percentages provided by the SORT are only estimates taking into account the general risks of the procedure and some information about the patient, but should not be confused with a patient-specific estimate in an individual case. As with all risk prediction tools, not every factor which may affect outcome can be included, and there may well be other patient-specific and surgical factors which may influence the risk of death significantly.

The resource is not intended to be used in isolation for clinical decision making and should not replace the advice of a healthcare professional about the potential risks or benefits of a planned procedure.

The discrimination of the SORT can be excellent, but it often over-estimates risk (i.e. can be poorly calibrated) particularly in higher risk patients. Healthcare professionals should not rely on, nor act upon, the mortality risk percentage without reviewing it and using it in conjunction with their clinical judgement/knowledge and as part of their overall toolkit.

Tips for using SORT

General

  • All values must be present before the calculation can take place.
  • Surgical severity will be calculated automatically on entry of procedure details.
  • If the procedure you are searching for is not listed, please use the nearest available procedure for calculation.

Cancer

When evaluating this parameter, ‘cancer’ refers to the presence of active malignancy within the past five years.

ASA scoring

  • Grade 1: A normal healthy patient
  • Grade 2: A patient with mild systemic disease
  • Grade 3: A patient with severe systemic disease
  • Grade 4: A patient with severe systemic disease that is a constant threat to life

Clinical Urgency

Clinical urgency is based on the NCEPOD classification of intervention (2004)

  • IMMEDIATE - Immediate life, limb or organ-saving intervention - resuscitation simultaneous with intervention. Normally within minutes of decision to operate
  • URGENT - Intervention for acute onset or clinical deterioration of potentially life-threatening conditions, for those conditions that may threaten the survival of limb or organ, for fixation of many fractures and for relief of pain or other distressing symptoms. Normally within hours of decision to operate.
  • EXPEDITED - Patient requiring early treatment where the condition is not an immediate threat to life, limb or organ survival. Normally within days of decision to operate.
  • ELECTIVE - Intervention planned or booked in advance of routine admission to hospital. Timing to suit patient, hospital and staff.
  • Grade 5: A moribund patient who is not expected to survive without the operation.

Results

Any patient with a SORT model risk prediction > 5% should:

  1. Be reviewed by the consultant anaesthesiologist on duty
  2. Be referred for a post-op bed in ICU