Pre-op Physiological Risk Assessment Tools for Surgical Patients
Research type
Research Study
Full title
Pre-operative Assessment of Elective Surgical patients - Development of Physiological Risk Assessment Tools.
IRAS ID
276302
Contact name
Ajith Siriwardena
Contact email
Sponsor organisation
Manchester University NHS Foundation Trust Address Trust Headquarters,
Duration of Study in the UK
3 years, 0 months, 1 days
Research summary
Functional capacity, muscle strength and postural coordination are proposed markers of frailty and significant predictors of patient outcomes following major surgery (Hasselager and Gögenur, 2014; Karam et al., 2013).
However, there exists no specific measurement in the pre-operative clinic setting test to categorise frailty using a reliable measure of global muscle function.
At Manchester University NHS Foundation Trust (MFT) Cardio-pulmonary Exercise Testing (CPET) is a comprehensive pre-operative test conducted prior to undertaking a range of major abdominal surgical procedures including vascular, hepatobiliary, colorectal and gynaecology. Results of CPET are used to risk stratify and guide clinical management of major surgical patients including type of operative procedure, anaesthetic technique and post-operative location. The established variables of CPET have also been explored in predicting outcomes following major surgery in various surgical specialities (Benington et al., 2019; Older et al., 1999; West et al., 2016).
Although it is widely accepted that post-operative complications are associated with reduced fitness, as yet no interaction between CPET variables and muscle function has been examined.
We propose to set up a risk assessment “tool box” for the pre-operative setting to investigate the predictors of post-operative risk using non-invasive measurements for muscle function and architecture combined with established CPET variables. This risk assessment will inform the future development of exercise interventions and treatments specific to the patients’ physiological profile.Lay summary of study results: We would like to thank the surgical patients who participated in this study.
This research study was a collaborative project between Manchester University Hospitals NHS Foundation Trust (MFT) and Manchester Metropolitan University (MMU). The study was part of a PhD project jointly supervised by MFT and MMU.
It is well known that poor physical function and weak muscle strength negatively impacts recovery following major abdominal surgery. The primary aim of this study was to develop and evaluate the use of non-invasive techniques to assess muscle size and architecture pre-operatively. The secondary aim was to evaluate how muscle architecture is affected by major abdominal surgery in the post-operative period during the inpatient stay and whether poor muscle architecture was associated with poorer outcomes within 6 months following surgery.
The study participants were MFT patients who were due to undergo scheduled, major hepatobiliary surgery at MFT. None of the patients had diagnosed muscular disease and none had undergone neoadjuvant chemotherapy treatment prior to their operation.
Patients who were due to attend a preoperative assessment at MFT as part of their routine care prior to major hepatobiliary surgery were invited to participate in the study with the aim of recruiting 60 patients for the study. During the routine pre-operative appointment, non-invasive, muscle measurements were also made to evaluate muscle size and strength of the patient prior to their surgery.
Muscle size was determined by ultrasound measurement of the lateral thigh muscle and muscle strength was evaluated using a load cell attached to the patients’ ankle. The patient was then asked to perform a kick action whilst seated to capture muscle strength. Post-surgery, during the last 3 days of in-hospital recovery muscle size of the lateral thigh muscle was evaluated once again using the ultrasound measurement.
The study was undertaken in clinical areas of MFT and did not impact on the routine care or treatment of any patient. No adverse effects of the muscle measurement techniques were experienced by any of the study participants.
Results of the study showed that patients with weaker and smaller muscles recover at the same pace as patients who have larger and stronger muscles following major hepatobiliary surgery. Any recorded loss of muscle size following major hepatobiliary surgery was not associated with worse outcomes in the six-month period following major hepatobiliary surgery. Furthermore, there was no association between muscle architecture and mortality within a six-month post-operative period following major hepatobiliary surgery. Endurance during the routine CPET was associated with length of hospital stay following major surgery.
The study has shown that a non-invasive method for evaluating muscle architecture can be incorporated into routine patient preoperative care. Although muscle architecture and changes recorded following major hepatobiliary surgery were not associated with short-term outcomes, the results from this study will be used to inform researchers about longer term outcomes in this patient group and other surgical specialties. The methods used in this study will also be incorporated into future care for patients undergoing major abdominal surgery.
The complete PhD thesis can be found via the following link:
https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.pstmrk.it%2F3ts%2Fe-space.mmu.ac.uk%252F633661%252F1%252FPabloDuro-Ocana.Thesis.pdf%2FNBTI%2F-ky4AQ%2FAQ%2F1a2d13ed-4b49-4bf9-8904-1a50a402c019%2F1%2FlsuaDvIK2e&data=05%7C02%7Ccoventryandwarwick.rec%40hra.nhs.uk%7C67f2accd5195498c6bef08dcdefb4568%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638630417981961403%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=4aaDIcLcGkOfwCErw0wZhFkmDs1qAT5x2rW8uWgINQ0%3D&reserved=0
Research papers describing the results of this project have been written and are pending publication.REC name
West Midlands - Coventry & Warwickshire Research Ethics Committee
REC reference
20/WM/0196
Date of REC Opinion
1 Sep 2020
REC opinion
Further Information Favourable Opinion