Defining the older patient population that require, but do not undergo emergency laparotomy: an observational cohort study protocol

Authors

  • Nicola Reeves University Hospital of Wales, Cardiff, UK
  • Susan Chandler Singleton Hospital, Swansea, UK
  • Elizabeth McLennan Royal Glasgow Infirmary, Glasgow, UK
  • Angeline Price Salford Royal NHS Foundation Trust, UK
  • Jemma Boyle RCS England, London School of Hygiene and Tropical Medicine, UK
  • Stephen Knight Centre for Medical Informatics, Usher Institute, University of Edinburgh, UK
  • Lyndsay Pearce Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, UK
  • Susan Moug Department of General Surgery, Royal Alexandra Hospital, Corsebar Road, Paisley, UK

DOI:

https://doi.org/10.18203/2349-3259.ijct20210977

Keywords:

Laparotomy, Older patient, Outcomes, Frailty

Abstract

Background: Despite older adults (65 years and above) accounting for almost half of emergency laparotomies and an ageing population, there remains a paucity of research in the older adult emergency surgery population. One key clinical area that requires urgent assessment is the older patient who presents with acute abdominal pathology treatable by laparotomy, but who does not undergo surgery (NoLAP).

Methods: This multicentre prospective cohort study [defining the denominator: emergency laparotomy and frailty study 2 (ELF2)] will recruit consecutive older adults that require but do not undergo emergency laparotomy (NoLAP). We will recruit from 47 national health service hospitals over a 3-month timeframe. The same criteria as NELA for inclusion and exclusion will be applied. The primary aim is 90-day mortality. Secondary aims include characterisation of the NoLAP group, frailty and sarcopenia with comparison to those older adults that have undergone emergency laparotomy (ELAP). Decision-making will also be explored. Assuming a NoLAP rate of 32% and 10% dropout, a minimum of 700 patients are required for 95% power (alpha=0.05).

Conclusions: The UK national emergency laparotomy audit has provided vital information on those patients undergoing emergency laparotomy and driven standards in operative and perioperative care. However, little is known of outcomes in those patients who do not undergo emergency laparotomy.  Improved understanding of this NoLAP population would aid shared decision-making and improve standards for this otherwise poorly understood vulnerable patient group.

Trial registration: This study is registered online at www.clinicaltrial.gov (Reg number: ISRCTN14556210).

 

References

NELA. National Emergency Laparotomy Audit. Available at: https://www.nela.org.uk/. Accessed on 3 June 2020.

Parmar KL, Pearce L, Farrell I, Hewitt J, Moug S. Influence of frailty in older patients undergoing emergency laparotomy : a UK-based observational study. BMJ Open. 2017;7(e017928):1-6.

Clegg A, Young J, Iliff S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381:752-62.

Parmar KL, Law J, Carter B, Hewitt J, Boyle JM, Casey P et al. Frailty in Older Patients Undergoing Emergency Laparotomy Results From the UK Observational Emergency Laparotomy and Frailty (ELF) Study. Ann Surg. 2019.

Carter B, Law J, Hewitt J, Parmar KL, Boyle JM, Casey P et al. The association between pre-admission frailty and care level at discharge in Older adults undergoing Emergency Laparotomy. BJS - Accept not yet Publ. 2020.

Broughton KJ, Aldridge O, Pradhan S, Aitken RJ. The Perth Emergency Laparotomy Audit. ANZ J Surg. 2017;87(11):893-7.

Mcilveen EC, Wright E, Shaw M, Edwards J, Vella M, Quasim T et al. A prospective cohort study characterising patients declined emergency laparotomy : survival in the ‘ NoLap ’ population. Anaesthesia. 2019; 75(1):54-62.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A New Method of Classifying Prognostic Comorbidity in Longitudinal Studies: Development and Validation. J Chronic Dis. 1987;40(5):373-83.

Rockwood K, Song X, Macknight C, Bergman H, Hogan DB, Mcdowell I et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):9-13.

Eugene N, Oliver CM, Bassett MG, Poulton TE, Kuryba A, Johnston C et al. Development and internal validation of a novel risk adjustment model for adult patients undergoing emergency laparotomy surgery : the National Emergency Laparotomy Audit risk model. Br J Anaesth. 2018;121(4):739-48.

Van Vugt JLA, Van den Braak RRJC, Schippers HJW, Veen KM, Levolger S, De Bruin RWF et al. Contrast-enhancement influences skeletal muscle density , but not skeletal muscle mass , measurements on computed tomography. Clin Nutr. 2017;1-8.

Rollins KE, Javanmard-emamghissi H, Awwad A, Macdonald IA, Fearon KCH, Lobo DN. Body composition measurement using computed tomography : Does the phase of the scan matter ? Nutrition. 2017;41:37-44.

Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT, Mccargar LJ et al. Cancer Cachexia in the Age of Obesity : Skeletal Muscle Depletion Is a Powerful Prognostic Factor, Independent of Body Mass Index. J Clin Oncol. 2013;31(12):1539-47.

Mourtzakis M, Prado CMM, Lieffers JR, Reiman T, Mccargar LJ, Baracos VE. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008;33(5):997-1006.

Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T et al. Sarcopenia : revised European consensus on definition and diagnosis. Age Ageing. 2018;48(1):16-31.

Downloads

Published

2021-04-22