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Published on: August 8, 2025
Optimizing Risk Prediction: Comparative Study of Surgical Outcome Risk Tool Versions 1 and 2 in Aortic Surgery
Dimitrios E Magouliotis1, Serge Sicouri1, Massimo Baudo2
1Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, USA.
Objectives:
To validate the Surgical Outcome Risk Tool (SORT) Versions 1 (V1) and 2 (V2) for predicting operative mortality in thoracic aortic surgery and compare their performance with established tools.
Design:
A retrospective cohort study.
Setting:
A single tertiary academic center.
Participants:
A total of 829 adult patients who underwent elective or emergency thoracic aortic surgery from 2014 to 2025.
Interventions:
We conducted a retrospective analysis of patients who underwent elective or emergency thoracic aortic surgery between January 2014 and June 2025. SORT V1, SORT V2, and EuroSCORE II, along with the Penn classification and the German Registry for Acute Type Aortic Dissection (in dissection cases) were calculated.
Measurements And Main Results:
Discriminative ability was assessed via the area under the receiver operating characteristic curve (AUC), and calibration was evaluated using the Hosmer-Lemeshow test, observed-to-expected ratios, model deviance, and Cox-Snell R². The overall operative mortality rate was 4.6% (38/829). In the total cohort, SORT V2 showed good discrimination (AUC = 0.82) and more reliable calibration than SORT V1 and EuroSCORE II. In dissection, the German Registry for Acute Type Aortic Dissection achieved the highest discrimination (AUC = 0.79), and the Penn classification showed the most favorable calibration; SORT V2 maintained acceptable calibration, comparing favorably with EuroSCORE II. Performance was preserved in prespecified subgroups and bootstrap internal validation supported the stability of estimates.
Conclusions:
In thoracic aortic surgery, SORT V2 provides a pragmatic option for preoperative risk estimation, with good discrimination and reliable calibration across the full cohort and key subgroups. Its inclusion of a preoperative clinical context rating may facilitate capturing case complexity. Multicenter studies are warranted to confirm generalizability and refine prediction in specific procedural settings.
