Emergency Laparotomy and Frailty: A national multicentre study of older surgical patients undergoing emergency laparotomy (ELF)

A National Observational Cohort Study led by the North West Research Collaborative

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Click Here for Participating Sites Information and Resources

Aim

To evaluate whether the use of a recognised frailty score (Rock Wood 7 point scale) correlates with outcomes following emergency laparotomy in patients aged 65 and over.

Background

The most recent NELA report (2016) has shown that over half of emergency general surgical patients are aged 65 and over and recommends that more be done to specifically target outcomes in this group of patients. Current risk prediction tools are mostly extrapolated from younger cohorts of patients and may be of less use in the older surgical population.

Frailty has been shown to be present in around 25% of older surgical patients with high pre-operative frailty scores being associated with increased post-operative complications, length of stay, 30 and 90 day mortality and likelihood of institutionalisation (Moug et al on behalf of OPSOC, Ann R Coll Surg Eng 2016; Hewitt et al, Am J Surg 2016; Farhat et al, J Trauma Acute Care Surg 2012). Most of these studies have been in elective rather than emergency surgery.

The use of a validated and easy to use frailty score may therefore permit the identification of at risk older emergency surgical patients and aid both decision making and the consent process.

Methods

This national observational study is being led by the North West Research Collaborative.  Data will be collected from fifty NHS hospitals across England, Scotland and Wales.  All patients aged 65 and over undergoing emergency laparotomy will be identified over an approximately three month period aiming for a sample size of 500 patients. Frailty scores will be assessed using the Rock Wood 7 point scale. The results database will be maintained using REDcap. Statistical support for data analysis is provided by OPSOC (Older Persons Surgical Outcomes Collaboraion).

Inclusion Criteria: Age 65+, Documented frailty score on admission, otherwise as per NELA

Exclusion Criteria: No documented frailty score, otherwise as per NELA

Outcome Measures: 90 day and 30 day mortality, Clavien Dindo post-operative complications, lowering of independence, length of stay, length of HDU/ICU stay, 30 day re-admission

Updates

  • Proportionate Ethical Review: Favourable opinion granted on 28-11-2016, favourable opinion for amended Protocol (version) granted Feb 2017
  • Presentations: 
    • North West Research Collaborative meeting 23-11-2016
    • Annual National Research Collaborative Meeting at RCS London 30-11-2016
    • NWSTC Trial Adoption Committee Meeting Dec 2016
  • North West Surgical Trials Centre: The ELF study has now been adopted by the NWSTC
  • Site Recruitment Closed: We currently have fifty sites registered in England, Scotland and Wales and are aiming for thirty.

ELF Study Timetable

Period Date
Case identification period 20/03/2017 – 19/06/2017
Data collection completion date 19/09/2017
Validation completion date 30/09/2017

Queries

  • Please see the  Participating Site Information and Resources page here
  • For any further queries please contact the committee by Email at: ELFcommittee@hotmail.com or use the contact form below.
  • Follow us on Twitter @ELFStudy

Contributors

Chief Investigator: Miss S Moug (Royal Alexandra Hospital NHS Trust)

Steering Committee:  K Parmar, J Boyle, P Casey, I Farrell, J Law, I Maitra

Other Contributors:  L Pearce, J Hewitt, OPSOC (Older Persons Surical Outcomes Collaboration)

 

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