/
A National Multi-Centre Study of Frail Older Surgical Patients undergoing Emergency Laparotomy A National Multi-Centre Study of Frail Older Surgical Patients undergoing Emergency Laparotomy

A National Multi-Centre Study of Frail Older Surgical Patients undergoing Emergency Laparotomy - PowerPoint Presentation

stefany-barnette
stefany-barnette . @stefany-barnette
Follow
350 views
Uploaded On 2018-11-07

A National Multi-Centre Study of Frail Older Surgical Patients undergoing Emergency Laparotomy - PPT Presentation

Kat Parmar ST7 General Surgery ELF Steering Committee chair ELF E mergency L aparotomy amp F railty ELF An Overview Who are the ELF team What is our research question Why is this relevant ID: 719160

elf patients emergency frailty patients elf frailty emergency royal frail general laparotomy research 2016 committee fit infirmary day people

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "A National Multi-Centre Study of Frail O..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

A National Multi-Centre Study of Frail Older Surgical Patients undergoing Emergency Laparotomy

Kat ParmarST7 General SurgeryELF Steering Committee chair

ELF

:

Emergency Laparotomy & FrailtySlide2

ELF - An Overview

Who are the ELF team?

What is our research question?Why is this relevant?

How do we plan to answer our research question?What do participating sites need to do?Slide3

ELF Team

Chief Investigator: Susan Moug, Consultant Colorectal Surgeon, OPSOC

Steering Committee (North West Research Collaborative): Kat Parmar, Jen Law, Jemma Boyle, Patrick Casey, Ian Farrell, Ishaan MaitraOPSOC

(Older Persons Surgical Outcomes Collaboration): Jonathan Hewitt (Geriatrician) Lyndsay Pearce (General Surgeon) Ben Carter (Statistics Lead)Slide4

ELF Study Proportionate Ethical review November 2016:

favourable opinion granted

NHS Research Ethics Committee (REC) Proportionate Review Service Ethical ApprovalSlide5

Research Question

Does the use of a validated frailty score correlate with outcomes in emergency laparotomies in older surgical patients?Slide6

Relevance

The most recent NELA report (2016) found that:

Over half of patients undergoing emergency general

surgical procedures are aged 65 and olderMore should be done to specifically target outcomes in these patientsCurrent risk prediction tools are generally extrapolated from cohorts of

much younger patients NELA project team. Second Patient report of the National Emergency Laparotomy Audit. RCoA London 2016Slide7

FrailtyA relatively new medical concept with many definitions

One definition: Various frailty scores have been developed and validated

‘A medical syndrome with multiple causes and contributors that is characterised by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death’Slide8

Frailty Scores - EvidenceResearch so far has suggested that high frailty scores pre-operatively correlate with:

The majority of these previous studies have been performed in elective rather than emergency patients

Moug et al on behalf of OPSOC, Ann R Coll Surg Eng 2016

Hewitt et al, Am J Surg 2016Farhat et al, J Trauma Acute Care Surg 2012

↑ post-operative complications ↑ length of stay ↑ 30 and 90 day mortality and ↑ likelihood of institutionalisation Slide9

Rockwood CHSA Frailty Score

 1 – Very fit

Robust, active, energetic, well motivated and fit; these people commonly exercise regularly and are in the most fit group for their age.

2 – Well

Without active disease, but less fit than people in category 1.

3 – Well, with treated comorbid disease

Disease symptoms are well controlled compared with those in category 4.

4 – Apparently vulnerable

Although not frankly dependent, these people commonly complain of being “slowed up” or have disease symptoms.

5 – Mildly frail

With limited dependence on others for instrumental activities of daily living.

6 – Moderately frail

Help is needed with both instrumental and non-instrumental activities of daily living.

7 – Severely frail

Dependent on others for activities of daily living, or terminally ill.

Rockwood K, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489-95Slide10

ELF Study Process

Identification of patients (~3 months)

Data collection↓Entry of data into central secure REDCap

Database ↓Analysis of data by ELF statistician↓Dissemination of resultsSlide11

ELF Study TimeframeSlide12

Outcome Measures

Primary Outcome Measure:

90 day mortalitySecondary Outcome Measures: LOS

ComplicationsChange in level of independenceLOS HDU/ICUIntermediate care stay30 day mortality & re-admissionSlide13

Sample SizeUsing unpublished OPSOC data, frailty exists in 28% of all patients undergoing emergency laparotomy

In order to detect a 10% difference in mortality rate at Day 90 between frail and non frail patients a sample size of 480 is requiredWe anticipate minimal patients that we are unable to follow up, but to account for this, we will aim to recruit 500 patients

166 patients/month

Monthly laparotomy rates in ≥65

yr olds: 5-9 per unit30 units needed for 500 patients in 3 months50 units recruitedSlide14

Case Report FormSlide15

Site List

1

Addenbrookes

2

Arrowe

Park

3

Ashford

4

Barnet General Hospital

5

Barrow

6

Birmingham QECH

7

Blackburn

8

Blackpool

9

Bolton

10

Brighton

11

Bristol Royal Infirmary

12

Cardiff

13

Chester

14

Crewe

15

Croydon

16

Doncaster

17

Dundee

18

East Surrey

19

Edinburgh Western General

20

Edinburgh Royal Infirmary

21

Essex

22

Exeter

23

Glamorgan

24

Glan

Clywd

25Glasgow QEUH

26

Glasgow Royal Infirmary

27

Kilmarnock

28

Lancaster

29

Maidstone & Tunbridge Wells

30

Macclesfield

31

Manchester Royal Infirmary

32

Mid Yorkshire

33

Milton Keynes

34

Newport

35

North Bristol

36

North Somerset

37

Oban

38

Orpington PRUH

39

Paisley

40

Portsmouth

41

Preston

42

Reading

43

Royal Surrey

44

Royal London

45

Salford

46

Swansea

47

Tameside

48

Taunton

49

Whiston

50

Wigan

51

Wrexham

52

WythenshaweSlide16

What Next for ELF?

REDCap Login Details:

→ All sites to submit names and Email addresses of local collaborators requiring REDCap login details

contact ELFcommittee@hotmail.comSlide17

Thank You

ELF

Steering Committee