Surgical Outcome Risk Tool (SORT) review: a preoperative clearance app

It is common practice in primary care to “clear” our patients for surgery, but we are not alone as our colleagues in internal medicine and anesthesiology frequently perform the same duty. Not a week goes by in my practice, and likely daily for my anesthesia colleagues, that patients bring paperwork from a surgeon asking for clearance. The question for many is what needs to be done? There are several evidence-based guidelines to help sort out the myriad of options and we have reviewed several preoperative apps before.

Just deciding whether or not a patient is “safe” to proceed to the operating room is not enough. Previously here on iMedicalApps we reviewed a wonderful medical app by Dr Joshua Steinberg called Preop Eval designed to assist providers in making these complicated decisions a lot easier. A more recent review evaluated the PreOpGuide from TEAM Health Anesthesia, and found it to be a another worthy addition to the preop process. Neither medical app includes information on the mortality risk in patients from the surgery itself.

A 2014 study in the British Journal of Surgery published the results of Surgical Outcome Risk Tool (SORT). The tool which was developed and validated by Protopapa, et al. predicts the 30 day mortality from surgery based on a number of variables including the type of surgery, surgery severity, physical status, age of patient, etc. The authors validated the study on an observational cohort of over 19,000 patients in the UK. The medical app — Surgical Outcome Risk Tool — takes the calculation derived from the study to create a useful point of care tool for informing the surgery team as well as patients and their families.

Clinical Scenario

Let’s walk through the medical app via a clinical case similar to one I saw in clinic recently. A 77 year-old obese male with insulin requiring Type II diabetes presents in clinic for a preop eval prior to undergoing a right hemicolectomy for recently diagnosed colon cancer. His past medical history is complicated by Type II diabetes, hypertension, and hyperlipidemia, but no history of stroke or heart disease. What is this patient’s predicted mortality at 30 days post-op?

Login to iMedicalApps in order to view the following video review of the SORT app. Registration for iMedicalApps is free.

Evidence based medicine

The medical app is based on the outcomes of the 2014 article by Protopapa, et al. entitled, “Development and validation of the Surgical Outcome Risk Tool (SORT). The app provides an evidence based prediction of the 30-day mortality after surgery in adults. The data for the app was derived from an observational study performed in the UK involving over 19,000 patients. The medical app does not replace standard preop clearance procedures (and their apps), but adds additional detail to the process of preop evaluation and patient counseling.

What providers would benefit from this Medical App?

Residents, mid-levels, Family Medicine, Internal Medicine, General Surgeons, Anesthesiologists, Nurse Anesthetists and any other provider who performs preop evals and/or counsels patients and their families about the risk of surgery.

Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.