AAGBI/Anaesthesia Research Grant

University College Hospital, London

Title
Patient-Centred Outcome Measures for Major Surgery (P-COMMaS)

Amount
£5,179

Scientific Abstract
Aim
To identify outcome measures of most importance to patients undergoing major surgery.

Hypothesis
Patients undergoing major surgery are more concerned about long-term postoperative quality of life than short-term postoperative recovery.

Background
Many perioperative research trials report outcomes of questionable relevance to patients. Recent research has focused on patient-centred outcome measures, but few studies have explicitly consulted patients having major surgery about which outcomes are most important to them.

Methods
This mixed-methods study will seek views of patients, carers and clinicians regarding important outcome measures after major surgery, using:

A) A survey, based on a recently completed systematic review of perioperative outcome measurement, with a recruitment target of 150-200 respondents

B) In-depth interviews exploring perspectives on major surgery, and how best to measure its outcomes.

Analysis
Survey: Numerical ratings of specific outcome domains, and differences between service users and clinicians, will be summarised using descriptive statistics.
Interviews: Interview transcripts will be thematically analysed to provide additional perspectives on postoperative outcomes.

Benefits
The results will inform the NIAA HSRC's 'Core Outcome Set for Perioperative and Anaesthetic Care' project. Core Outcome Sets improve the relevance of research to patients and clinicians, facilitate systematic reviews, and enable comparison of results between trials.

Leeds Institute of Biomedical & Clinical Sciences, School of Medicine, University of Leeds

Title
MET-REPAIR-FRAILTY: REevaluation for Perioperative cArdIac Risk and FRAILTY

Amount
£21,759

Scientific Abstract
European and American guidelines for preoperative cardiovascular risk stratification recommend assessment of physical functional capacity. MET-REPAIR is a European multi-centre prospective cohort study which will recruit 15,000 patients undergoing major non-cardiac surgery to address the question of whether questionnaire based assessment of functional capacity improves pre-operative risk assessment.

Frailty is also known to increase the risk of perioperative complications but the best and most practical tool for preoperative assessment of frailty is not known and it has not been shown in large population studies that frailty assessment improves preoperative risk stratification.

We will conduct MET-REPAIR in the UK and add MET-REPAIR-FRAILTY, a sub-study to determine the added value from the Clinical Frail Scale, the Edmonton Frail Scale, a timed walk assessment and the electronic Frailty Index (eFI). Baseline data collection will include risk factors for cardiovascular complications, questionnaire assessed functional capacity and frailty assessments. Outcome data will include mortality, cardiovascular complications, Clavien-Dindo classification and length of stay. Statistical modelling will be undertaken to determine if questionnaire assessed functional capacity adds information to preoperative risk assessment. Additional statistical modelling will be performed to determine if frailty assessment in the pre-assessment clinic further improves preoperative risk stratification.

Bolton NHS Foundation Trust

Title
Upper limb disorders in anaesthetists

Amount
£4,920

Scientific Abstract
Background
Work-related musculoskeletal disorders account for ~40% of NHS sickness absences, with arm and neck disorders affecting 730:100,000 UK employees. Anecdotally, anaesthetists are prone to such disorders, especially neck problems, possibly related to repeated/prolonged poor posture e.g. during airway management, but the prevalence is unknown. If true, increased risk of upper limb disorders amongst anaesthetists may threaten both anaesthetic service provision through ill-health/sick leave, and patient safety through impaired performance of practical procedures.

Aims
To ascertain the prevalence of upper limb disorders in anaesthetists in the UK and Ireland, and explore relationships with potential risk factors.

Methods
An electronic survey will be sent to all ~11,000 AAGBI members, asking a limited set of questions to identify upper limb disorders and potential risk factors e.g. age, height, weight, gender etc. The questions will be limited and focused, to encourage a good response rate, with potential for a follow-up study to explore some conditions/risk factors in more detail. The survey will be administered by a company used by the AAGBI before, the associated cost covering its involvement. The results will be presented/disseminated in order to raise awareness and inform any subsequent steps around education/training and attention to workplace ergonomics.

Sheffield Teaching Hospitals NHS Foundation Trust

Title
PROtective ventilation with high versus low PEEP during one-lung ventilation for THORacic surgery - PROTHOR: A randomized controlled trial

Amount
£11,725

Scientific Abstract
Postoperative lung complications (PPCs) after thoracic surgery employing one lung ventilation OLV are common. How to best reduce the incidence of PPCs in terms of
ventilation technique is uncertain. This is the UK arm of a multinational study(designed by the PROVE Group, including the principle applicant) aiming to assess whether OLV with low tidal volumes, relatively high levels (10 cmH2O) of positive end-expiratory pressure (PEEP) and lung recruitment manoeuvres produces fewer PPCs compared to low PEEP (5 cmH2O). Patients included are scheduled for open thoracic or video-assisted thoracoscopic surgery under GA requiring OLV; Body mass index (BMI)<35 kg/m2; Age > 18 years.

The primary endpoint is the proportion of patients developing PPCs. Secondary endpoints are intraoperative complications; extended PPCs; postoperative extra-pulmonary complications; need for unexpected ICU admission/readmission; number of hospital-free days (day 28); day 90 survival; PaO2, PaCO2, arterial pH during OLV; need for postoperative respiratory interventions.
Power: OLV in a prospective observational, multicentre study (LASVEGAS) gave a 23% incidence for a PPC composite. Two sided significance (95% level) and power 90%, produced a sample size of 2259 spread across many countries. In the UK we will recruit a minimum of 72 patients in six sites (6x12).

Royal Victoria Infirmary

Title
Emergency Laparotomy Follow-up Study: A pilot, single-centre, observational study into the medical, functional and social impact of emergency abdominal surgery during the first year of recovery. (ELFUS1)

Amount
£9,913

Scientific Abstract
Emergency laparotomy (EL) is a common, high-risk operation. Over 30,000 UK patients undergo EL each year, many elderly, and at high risk of postoperative complications including a 20% mortality risk in the over-70s. The National Emergency Laparotomy Audit produces comparative process and outcome data but is unable to describe in any detail the incidence and consequences of postoperative complications following EL. Data capture finishes with hospital discharge, so little information is gathered to describe readmission or its consequences. There is currently little information available about the longer-term outcomes and morbidities experienced by EL patients.

We aim to study the incidence of complications whilst patients recover in hospital following EL. We will then follow patients for a year after surgery, using validated questionnaires (EQ5D and WHODAS 2.0) to look at how they have been affected by their surgery in terms of caring for themselves, dependency, memory and mood, and ongoing pain issues. We will start to clarify what need there has been for hospital readmission, support from primary care services, and the extent of any social care packages required.

Our feasibility study has been designed to test our proposed methodologies in a single centre before developing a larger multi-centre study.