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Enhanced Perioperative Care for the Prevention of Colorectal Anastomotic Leakage (DOUBLE CHECK)

21. februar 2022 opdateret af: Freek Daams, Amsterdam UMC, location VUmc

Enhanced Perioperative Care for Improving Outcomes After Colorectal Resection by Implementation of Best Practice for the Prevention of Anastomotic Leakage - Double Check Study: Protocol for a Multicenter Open-label Trial

This multicenter open-label trial is designed to evaluate if the implementation of an enhanced peri-operative care protocol results in an optimal intraoperative condition of the patient and in a decrease in incidence of anastomotic leakage after colorectal resection as compared to current practice.

Studieoversigt

Status

Aktiv, ikke rekrutterende

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Rationale Colorectal anastomotic leakage (CAL) remains a severe complication following surgery with a reported incidence of 3-19% worldwide. Recent research has identified several modifiable peri-operative CAL risk factors, suggesting that the intraoperative condition of the patient plays an important role in CAL development.

Objective To successfully implement an enhanced perioperative care protocol, focusing on optimizing the intraoperative condition of the patient to minimalize exposure to CAL risk factors. Secondly, to investigate whether implementation of this new guideline results in a better intraoperative condition and a decreased CAL rate as compared to current practice.

Study design An open-label multicenter design with historical cohort in nine participating hospitals.

Study population All adult patients that are scheduled for a colorectal resection with creation of a primary anastomosis.

Intervention An enhanced perioperative best practice protocol. The Double Check bundle exists out of interventions applicable without the introduction of new material to the operating room, on top of usual care. The protocol is based on the results of our previous large, multicenter, international observational cohort study (LekCheck study), systematic literature analyses, an inventory in current protocols on peri-operative care and expert opinion. Consensus is reached with colorectal surgeons from all participating centers. The final protocol was reviewed critically by experts in the field of colorectal surgery before implementation.

Comparison 1592 historical patients that were treated with standard practice (LekCheck study group). In addition the anastomotic leakage rates from the national registry of the period after the LekCheck study and before the start of the Double Check study will be used for comparison.

Endpoints Compliance to the study protocol, the patient's intraoperative condition and exposure to modifiable intraoperative risk factors, 30-day CAL and other postoperative complications according to Clavien-Dindo classification. Follow-up will be 90 days after colorectal resection.

Undersøgelsestype

Interventionel

Tilmelding (Forventet)

1600

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Belgien
      • Antwerpen, Belgien
        • UZA
  • Holland
    • Limburg
      • Helmond, Limburg, Holland
        • Elkerliek
      • Maastricht, Limburg, Holland
        • Maastricht UMC+
    • Noord Brabant
      • Den Bosch, Noord Brabant, Holland
        • Jeroen Bosch Ziekenhuis
      • Uden, Noord Brabant, Holland
        • Bernhoven
      • Veldhoven, Noord Brabant, Holland
        • Maxima Medisch Centrum
    • Noord Holland
      • Amsterdam, Noord Holland, Holland
        • Amsterdam UMC
      • Hoorn, Noord Holland, Holland
        • Dijklander ziekenhuis
    • Zeeland
      • Terneuzen, Zeeland, Holland
        • ZorgSaam

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Barn
  • Voksen
  • Ældre voksen

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Age 18 and above
  • Bowel (small intestine/colon/rectal) resection with creation of a primary anastomosis
  • Ability to give informed consent

Exclusion Criteria:

  • The need for emergency surgery
  • Scheduled operation concerning a reoperation for complications from recent surgery (within 3 months after the initial procedure).
  • The inability to read or understand informed consent material

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Ikke-randomiseret
  • Interventionel model: Crossover opgave
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Double Check enhanced perioperative care protocol
Perioperative care according to a best practice protocol focussing on optimizing the intraoperative condition of the patient and thereby minimalize exposure to 6 known modifiable independent intraoperative risk factors: anemia, hypothermia, epidural anesthesia, vasopressor drug administration, incorrect antibiotic prophylaxis and hyperglycemia.
Andet: Enhanced perioperative care protocol
See arm/group description
Ingen indgriben: Current practice
Perioperative care according to usual practice. Historical controls from the previously conducted LekCheck study will be used as replacement of a control arm.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Number of modifiable intraoperative CAL risk factors present during surgery as assessed by the DoubleCheck list
Tidsramme: Intraoperative phase

The primary outcome of the study is the intraoperative condition of the patient measured by the number of modifiable intraoperative CAL risk factors present in the patient.

During the operation, the Double Check list will be completed.

The list exists of 6 risk factors of interest:

  • Anemia: haemoglobin level < 7,5 (women) or < 8.0 (men) mmol/L
  • Hypothermia: temperature <36 degrees Celcius
  • Hyperglycemia: glucose level >10 mmol/L
  • Ue of vasopressor drugs: yes
  • Epidural analgesia
  • Incorrect antibiotic prophylaxis: not administered within 15-60 minutes prior to incision

The number of risk factors present will be counted and a score of 0 to 6 will be given to each individual patient.
Intraoperative phase

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Colorectal anastomotic leakage (CAL)
Tidsramme: 30 days after surgery
Defined as a grade B or C according to the ISREC classification
30 days after surgery
Postoperative complications
Tidsramme: 30 days after surgery
Defined as any adverse event occurring in the postoperative period until 30 days after surgery and graded according to the Dindo-Clavien classification
30 days after surgery
Postoperative mortality
Tidsramme: 30 days after surgery
Measured as rate of death at 30-day follow-up
30 days after surgery
Hospital Stay
Tidsramme: 30 days after surgery
Length of hospital and intensive care unit stay
30 days after surgery
Readmission
Tidsramme: 30 days after surgery
30-day readmission rate
30 days after surgery

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Amsterdam UMC, location VUmc

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

5. september 2021

Primær færdiggørelse (Forventet)

1. september 2023

Studieafslutning (Forventet)

1. december 2023

Datoer for studieregistrering

Først indsendt

20. januar 2022

Først indsendt, der opfyldte QC-kriterier

21. februar 2022

Først opslået (Faktiske)

22. februar 2022

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

22. februar 2022

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

21. februar 2022

Sidst verificeret

1. februar 2022

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • 2020.0634

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

Ja

IPD-planbeskrivelse

The datasets generated during and/or analysed during the current study are/will be available upon request from dr. F. Daams

IPD-delingstidsramme

Upon request

IPD-delingsadgangskriterier

Upon request

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

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