Risk Calculators Validation for Elective Major General Surgery (RCVEMG)

November 7, 2019 updated by: Matthew Chan, Chinese University of Hong Kong

Validation of Postoperative Mortality Prediction for Elective Major Surgical Operation With Existing Risk Calculators Based on Preoperative Parameters

Nowadays, over 300 million surgical operations take place every year worldwide, which increase at a rate of 33.6% comparing data from 2005 to 2013. According to Surgical Outcomes Monitoring and Improvement Program (SOMIP) reports, which is an Hospital Authority-wide (HA-wide) audit on postoperative outcomes, a growth in major and ultra-major operations performed in our locality is also observed between 2008 and 2016, which leads to an increasing demand of high dependency and intensive care in the postoperative period. With the advancement in surgical technology, increasing surgical complexity and aging population have raised concerns towards perioperative costs and postoperative complications. Therefore, there is a need of an objective tool for risk stratification, which would be useful to guide clinical decision in terms of the magnitude of operation, level of intraoperative monitoring and postoperative placement plan.

Various risk scoring systems have been developed nowadays and each has its own limitations. As nowadays, the calculated risk score is commonly used in shared decision making process with patient and among the perioperative team. Risk calculation solely based on preoperative parameters will be more practical for daily clinical use. Therefore, in this study, the investigators would like to validate the postoperative mortality prediction with the risk calculators that are established merely using preoperative variables. Hopefully this would guide the future risk stratification in patients undergoing elective major surgical operation.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Detailed Description

Nowadays, over 300 million surgical operations take place every year worldwide, which increase at a rate of 33.6% comparing data from 2005 to 2013. According to Surgical Outcomes Monitoring and Improvement Program (SOMIP) reports, which is an Hospital Authority-wide (HA-wide) audit on postoperative outcomes, a growth in major and ultra-major operations performed in our locality is also observed between 2008 and 2016, which leads to an increasing demand of high dependency and intensive care in the postoperative period. With the advancement in surgical technology, increasing surgical complexity and aging population have raised concerns towards perioperative costs and postoperative complications. An international prospective cohort study revealed that globally 1 in 6 patients experienced a complication before hospital discharge and 1 in 35 patients who experienced a complication subsequently died without leaving the hospital. Therefore, there is a need of an objective tool for risk stratification, which would be useful to guide clinical decision in terms of the magnitude of operation, level of intraoperative monitoring and postoperative placement plan.

There are a variety of risk stratification tools available for use in major non-cardiac surgery. Among all, the American Society of Anaesthesiology Physical Status (ASA-PS) evaluation scale is the most commonly used risk evaluation system in the assessment of patients' physical status in the preoperative period. Although ASA-PS is well-validated in previous studies and simple to use, inter-rater reliability and the lack of consideration in the surgical perspective have raised concerns towards the development of risk prediction models to supplement clinical judgements and strengthen operative mortality estimation. In 2013, a qualitative systematic review found that Portsmouth Variation of the Physiological and Operative Score for the enUmeration of Mortality and Morbidity (P-POSSUM) and Surgical Risk Scale (SRS) to be the most reliable multivariate risk scoring systems,, but both were noted to have limitations. P-POSSUM has overcome the issues of risk overestimation and inadequate generalization across various surgical specialties by POSSUM. But the calculation requires 12 physiological and 6 operative variables, some of which requires subjective interpretation e.g. chest X-ray. These makes P-POSSUM labour-intensive for clinical use. Whereas SRS requires fewer data for risk calculation, it has only been validated in a single centre study.

In recent years, newer risk prediction models like the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) model and Preoperative Score to Predict Postoperative Mortality (POSPOM) have been developed to provide a more comprehensive perioperative risk prediction for patients undergoing major operation. ACS-NSQIP model is developed based on high-quality clinical data from ACS-NSQIP and is described as a universal risk calculator, which includes a Surgeon Adjustment Score (SAS) that allows further score modification according to surgical performance. However, owing to the high dependence on preoperative laboratory results, ACS-NSQIP often encounters problems where these parameters are not readily available in emergency situations. POSSOM model involves 17 predictor variables. Together with its excellent discrimination and calibration properties demonstrated in its validation cohort and the easily referable rating system, POSSOM is considered a robust tool for 1-year postoperative mortality prediction. However, further reviews on its external validation are yet available.

In 2014, a new risk stratification tool, Surgical Outcome Risk Tool (SORT) was developed in the UK to predict 30-day mortality after non-cardiac surgery in adults, based on post hoc analysis of data in the Knowing the Risk study from the observational National Confidential Enquiry into Patient Outcome and Death (NCEOPD). SORT is a multivariate risk scoring system, which includes 6 variables: 1) American Society of Anesthesiologists Physical Status (ASA-PS) grade, 2) urgency of surgery, 3) surgical specialty, 4) surgical magnitude, 5) cancer or non-cancer surgery and 6) age.

In 2018, the Combined Assessment of Risk Encountered in Surgery (CARES) surgical risk calculator has been developed based on Singapore local data, which makes use of 9 preoperative parameters namely: 1) age, 2) gender, 3) ASA classification, 4) surgical risk group, 5) emergency surgery, 6) anaemia status, 7) red cell distribution width (RDW), 8) ischaemic heart disease, , 9) congestive heart failure for prediction of postsurgical mortality and need for intensive care unit admission.

When the investigators look into each of these existing risk stratification tools, each of the risk calculators possesses its drawbacks when coming into clinical applications. As nowadays, the calculated risk score is commonly used in shared decision making process with patient and among the perioperative team. Risk calculation solely based on preoperative parameters will be more practical for daily clinical use. Therefore, in this study, the investigators would like to validate the postoperative mortality prediction with the risk calculators that are established merely using preoperative variables. Hopefully this would guide the future risk stratification in patients undergoing elective major surgical operation.

Study Type

Observational

Enrollment (Anticipated)

5000

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Hong Kong
      • Hong Kong, Hong Kong
        • Recruiting
        • Department of Anaesthesia and Intensive Care, New Territories West Cluster, Hospital Authority
        • Contact:
        • Contact:
        • Sub-Investigator:
          • Carmen KM Lam, MBBS
        • Sub-Investigator:
          • Benny CP Cheng, MBBS
        • Principal Investigator:
          • Vincent KC Yau, MBBS

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Patients who received scheduled major surgical operation in Tuen Mun Hospital during from 01July 2012- 30June 2018

Description

Inclusion Criteria:

  1. patient aged 18 years or over
  2. undergoing elective major surgical operation*
  3. requiring a planned overnight admission

Exclusion Criteria:

  • Patients undergoing day case surgery, obstetric procedures, neurosurgery, cardiac or transplant surgery were excluded.
  • Patient were also excluded if any of the key variables were missing

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Retrospective

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Elective Surgical Patients in Tuen Mun Hospital
Patients who received elective surgical operation in Tuen Mun Hospital from 1July 2012 to 30June 2018
Procedure: Major surgical operation
Surgical operation with magnitude defined as major or ultra-major

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
30-day mortality rate
Time Frame: 30 days postoperatively
The Rate of Mortality at or within 30 days after the elective major surgical operation
30 days postoperatively

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
1-year mortality rate
Time Frame: 1 year postoperatively
The Rate of Mortality at or within 1 year after the elective major surgical operation
1 year postoperatively

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Chinese University of Hong Kong

Collaborators

Tuen Mun Hospital

Investigators

  • Principal Investigator: Matthew TV Chan, MBBS, Department of Anaesthesia and Intensive Care, CUHK

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

November 1, 2019

Primary Completion (Anticipated)

December 31, 2020

Study Completion (Anticipated)

December 31, 2020

Study Registration Dates

First Submitted

July 30, 2019

First Submitted That Met QC Criteria

July 31, 2019

First Posted (Actual)

August 1, 2019

Study Record Updates

Last Update Posted (Actual)

November 12, 2019

Last Update Submitted That Met QC Criteria

November 7, 2019

Last Verified

November 1, 2019

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • RCVEMG Protocol V2.0

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Death

Clinical Trials on Major surgical operation

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Trinidad & Tobago

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Subscribe