Frailty, Frail Elderly Syndrome, Surgery
Conditions
Brief summary
A single-centre prospective study of feasibility assessing the suitability of introducing routine frailty screening in a controlled, and reproducible, outpatient department setting for Vascular Surgery patients. This study will also perform head-to-head comparisons of the prognostic value of five frailty assessment tools, selected based on the previous demonstration of their popularity and familiarity within the speciality, their designs being based on different theories of frailty and that some are endorsed by local healthcare police. Inter-user variability (patient self assessment and clinician assessment will also be compared).
Detailed description
This single-centre prospective cohort study of feasibility, is conducted in a rapid-referral vascular surgery clinic, serving a population of 2 million. Capax adults (\>18years), attending clinic for any reason are eligible for inclusion. Five frailty assessments are completed at the clinic by patient (Rockwood Clinical Frailty Scale \[CFS\] and Frail NonDisabled Questionnaire \[FiND\]), clinician (CFS, Health care Improvement Scotland FRAIL Scale and 'Initial Clinical Evaluation') and researcher (11-item modified Frailty Index, mFI-11). Consistent with feasibility objectives, outcome measures include recruitment rates, frailty assessment completion rates, time-to-complete assessments and inter-rater variability. Electronic follow-up at 30-days and 1-year will assess home-time and mortality as prognostic indicators. Patients treated surgically/endovascularly will undergo additional 30-day and 1-year post-operative follow-up, outcome measures include: surgical procedure, mortality, complications (according to Clavien-Dindo Classification), length-of-stay, readmission rates, non-home discharge, home-time, higher social care requirements on discharge and amputation-free survival. Prognostic value will be compared by area under Receiver operator characteristic (ROC) curves. Continuous outcome variables will be analysed using Spearman's rank correlation coefficient. Inter-user agreement will be compared by percentage agreement in Cohen's Kappa coefficient.
Interventions
DIAGNOSTIC_TESTFrailty assessment
Rockwood Clinical Frailty Scale
Sponsors
University of Glasgow
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Adults (aged 18 years or older) * Attending Vascular Hot Clinic
Exclusion criteria
* Lacking capacity to provide informed consent * Parent clinical team feel frailty assessment not suitable * Non-English speaker without qualified translator present * Prisoners
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility of implementing routine frailty assessment in a vascular clinic setting | During participant recruitment, over up to 4 months. | Proportion of patients recruited (Number of recruited patients/\[number of patients attending clinic - number of ineligible patients\]). |
| Frailty assessment completion time | During participant recruitment, over up to 4 months. | Time taken to complete assessments (presented in seconds). The less time taken, the better. |
| Frailty assessment completion rates | During participant recruitment, over up to 4 months. | Proportion of assessments with non-completion. Calculated by: number of incomplete frailty assessments/total number of recruited patients, the lower the value the better. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Assessing the peri-operative prognostic value of selected frailty assessment tools (Complications) | 30-days and 1 year from primary intervention offered following recruitment to study. | For patients offered endovascular/surgical/hybrid intervention: post-operative complications (according to the Clavien-Dindo Classification). |
| Assessing the peri-operative prognostic value of selected frailty assessment tools (Length of stay) | 30-days and 1 year from primary intervention offered following recruitment to study. | For patients offered endovascular/surgical/hybrid intervention: length of hospital stay (full days). Calculated as number of full days as inpatient following admission for index procedure. |
| Assessing the peri-operative prognostic value of selected frailty assessment tools (Readmission) | 30-days from primary intervention offered following recruitment to study. | For patients offered endovascular/surgical/hybrid intervention: readmission rates (to any speciality). This will be calculated by the proportion of patients readmitted to hospital following index procedure/the number of patients undergoing surgical/endovascular treatment. |
| Assessing the prognostic value of selected frailty assessment tools (Home time - all patients) | 30-days and 1 year from recruitment/clinic attendance | 'Home time': this describes the number of full days at home (not as a hospital inpatient) over the follow up periods. All recruited patients will undergo this follow-up. |
| Assessing the peri-operative prognostic value of selected frailty assessment tools (Home time) | 30-days and 1 year from primary intervention offered following recruitment to study. | For patients offered endovascular/surgical/hybrid intervention: home time. See outcome 4. |
| Assessing the peri-operative prognostic value of selected frailty assessment tools (Social care requirements) | 30-days from primary intervention offered following recruitment to study. | For patients offered endovascular/surgical/hybrid intervention: discharge with a higher level of social care requirements. This will be presented as the proportion of patients discharged with greater social care requirements than before their index admission/'total number of patients offered surgical or endovascular treatment. E.g., a patient is admitted preopertively with three times daily package of care and discharged with four times daily package of care |
| Assessing the peri-operative prognostic value of selected frailty assessment tools (Non-home discharge) | 30-days from primary intervention offered following recruitment to study. | For patients offered endovascular/surgical/hybrid intervention: non-home discharge. This will be calculated by the proportion of patients who are discharged to place of residence differing from their preoperative residence/total number of patients undergoing surgical/endovascular treatment. For example, from private residence preoperatively to care home. |
| Assessing the prognostic value of selected frailty assessment tools (Mortality - all patients) | 30-days and 1 year from recruitment/clinic attendance | Mortality: this will be calculated from date of recruitment. All recruited patients will undergo this follow-up. |
| Assessing the peri-operative prognostic value of selected frailty assessment tools (Mortality) | 30-days and 1 year from primary intervention offered following recruitment to study. | For patients offered endovascular/surgical/hybrid intervention: mortality. Proportion of patients dead at follow up. |
Countries
United Kingdom
Contacts
Primary ContactWelsh
Outcome results
None listed