AAGBI/Anaesthesia Research Grants

The James Cook University Hospital, Middlesbrough

Title
Investigating the associations between patient reported outcomes and preoperative frailty in patients with operable, potentially curative, colorectal cancer: an observational study

Amount
£40,000

Scientific Abstract

Background: Frailty is common in older patients undergoing surgery and renders affected individuals at increased risk of adverse perioperative outcomes. The impact of frailty on patient reported outcome measures (PROMs) e.g. quality of life (QoL) is less well described in the literature for the perioperative period. This information is however critical in aiding shared decision-making amongst patients and clinicians to determine if surgery is the most appropriate intervention.

Aim: To investigate the association between PROMs and preoperative frailty in older patients with operable, potentially curative, colorectal cancer.

Method: This is multi-centre observational study, of approximately 250 patients aged >65, undergoing surgery for colorectal cancer. Frailty scores (Edmonton Frailty Scale, Clinical Frailty Score) and PROMs for QoL and functional disability (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 item, World Health Organisation Disability Assessment Schedule) will be recorded preoperatively and at 6 and 12 weeks postoperatively. Data on perioperative morbidity and 90-day mortality will be collected.

Analysis: Statistical modelling techniques will be used to investigate the associations between preoperative frailty and changes in QoL and functional disability consequent to surgery.

Impact: Results will provide critical information to inform a future definitive randomised control trial.

Royal United Hospitals Bath NHS Foundation Trust

Title
The Videolaryngoscope Airway Database App Project

Amount
£4,882

Scientific Abstract

Aims:
This project plans to create and develop an app and database, to collect data on all videolaryngoscopy intubations performed in theatres, ICU and the Emergency Department at the Royal United Hospital Bath.

Background:
Compared to direct laryngoscopy, videolaryngoscopy is associated with fewer failed intubations, better laryngoscopy views and less airway trauma. However, there is little data on the associated incidence of hypoxia and death and its use in different high-risk patient groups and hospital settings. The hospital has transitioned to using the C-MAC videolaryngoscope for all intubations. With 5,000 intubations per year, it can begin to build a database that currently does not exist, to explore the performance, limitations, safety profile and associated complications of the C-MAC amongst an unadjusted 'real-world' patient population.

Methods:
The app, accessed via a smart phone or hospital-desktop, will include a questionnaire to complete on each intubation. Data will be regularly analysed and fedback to clinical governance and patient safety bodies across the hospital, instigating changes to practice in response to need, to improve the quality of care provided to patients.

Conclusion:
Success dependant, there is the potential to disseminate the app to other hospitals across the UK, to form a national airway database.

Royal United Hospitals Bath NHS Foundation Trust

Title
Improving outcomes for frail patients undergoing elective colorectal cancer surgery

Amount
£17,479

Scientific Abstract

Aims:
The project aims to improve decision-making, quality of care and outcomes for frail patients undergoing elective colorectal cancer surgery through the implementation of a new individualised 'prehabilitation' pathway through a continuous QI process over a 6-month period.

Background:
Frailty is associated with higher mortality, increased postoperative complications and longer length of stays. There is greater acknowledgement of the potential postoperative benefits of preoperative optimisation but the ideal 'prehabilitation' programme has yet to be clarified.

Methods:
The project seeks to embed routine screening and anaesthetic review of frail patients who are planned to undergo elective colorectal cancer surgery, while trialling whether a preoperative exercise and nutrition programme as part of 'prehabilitation' improves outcomes for this patient cohort.

Conclusions:
Should this be successful, the project will then look to disseminate the programme to all frail patients undergoing elective surgery.

Leeds Teaching Hospitals NHS Trust

Title
Teicoplanin Anaphylaxis: Development of a diagnostic pathway, and elucidation of the underlying allergic mechanism

Amount
£20,000

Scientific Abstract
Incidence of anaphylaxis to teicoplanin has increased in parallel with a considerable expansion in its use, in response to the changing patterns of antibiotic resistance. The recent National Audit Project 6 study demonstrated that teicoplanin is the single most allergenic drug given by anaesthetists, tending to cause severe reactions which may be fatal. There are currently no validated diagnostic tools for testing patients with suspected teicoplanin allergy, and the diagnosis can be missed, or mis-attributed. Where the diagnosis of allergy can be neither proven nor refuted, patients are vulnerable to significant future harm through inappropriate antibiotic prescribing. The health benefits of an accurate diagnosis are significant for both the individual as well as the wider NHS. We hypothesise that a diagnosis of allergy to teicoplanin can be established through a comprehensive pathway, which includes in-vivo and in-vitro testing. In addition, we aim to advance the mechanistic understanding of the allergic process and of individual susceptibility to these reactions.