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Perioperative Endothelial Dysfunction in Patients Undergoing Major Acute Abdominal Surgery (POETRYabd)

14. februar 2021 oppdatert av: Sarah Victoria Ekeløf Busch, Zealand University Hospital

Perioperative Endothelial Dysfunction in Patients Undergoing Major Acute Abdominal Surgery. The POETRY Abdominal Study

The aim of the clinical study is:

  1. to examine the association between postoperative endothelial function, indirectly measured by reactive hyperemia index, and major adverse cardiovascular events including myocardial injury and cardiac death within 30, 90 and 365 days of acute abdominal surgery.
  2. to examine the association between postoperative endothelial function, indirectly measured by reactive hyperemia index, and non-cardiovascular complications including non-cardiac death within 30, 90 and 365 days of acute abdominal surgery.
  3. to examine the importance of the postoperative blood glucose level and the pulmonary function for postoperative complications and death within 30, 90 and 365 days of acute abdominal surgery.
  4. to examine the association between postoperative endothelial function, pulmonary function and blood glucose level
  5. the qualitative part of the study will examine the postoperative subjective symptoms including acute and chronic pain, quality of recovery and functional status, depressive thoughts and post-traumatic stress disorder.

Studieoversikt

Studietype

Observasjonsmessig

Registrering (Faktiske)

224

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

      • Køge, Danmark, 4600
        • Department of Surgery, Zealand University Hospital, Koge

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år og eldre (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Prøvetakingsmetode

Sannsynlighetsprøve

Studiepopulasjon

Patients undergoing major acute gastrointestinal surgery

Beskrivelse

Inclusion criteria

  • ≥ 18 years old
  • Surgery within 72 hours of an acute admission to the Department of Surgery or an acute reoperation.
  • Major gastrointestinal surgery on the gastrointestinal tract. This will include
  • Open, laparoscopic, or laparoscopically-assisted procedures
  • Procedures involving the stomach, small or large bowel, or rectum for conditions such as perforation, ischaemia, abdominal abscess, bleeding or obstruction
  • Washout/evacuation of intra-peritoneal abscess (unless due to appendicitis or cholecystitis - excluded, see below)
  • Washout/evacuation of intra-peritoneal hematoma
  • Bowel resection/repair due to incarcerated umbilical, inguinal and femoral hernias (but not hernia repair without bowel resection/repair)
  • Bowel resection/repair due to obstructing/incarcerated incisional hernias provided the presentation and findings were acute
  • Laparotomy/laparoscopy with inoperable pathology (e.g. peritoneal/hepatic metastases)
  • Laparoscopic/Open Adhesiolysis
  • Return to theatre for repair of fascial dehiscence
  • Any reoperation/return to theatre meeting the criteria above is included

If multiple procedures (primary surgery or reoperation) are performed on different anatomical sites within the abdominal/pelvic cavity, the patient would be included if the major procedure is general surgical.

Exclusion criteria

  • Not capable of giving informed consent after oral and written information
  • Previously included in the trial
  • If transferred directly from the operation room or recovery ward to the intensive care unit
  • Elective laparoscopy
  • Diagnostic laparotomy/laparoscopy where no subsequent procedure is performed (NB, if no procedure is performed because of inoperable pathology, then include)
  • Appendectomy +/- drainage of localized collection unless the procedure is incidental to a non-elective procedure on the GI tract
  • Cholecystectomy +/- drainage of localized collection unless the procedure is incidental to a non-elective procedure on the GI tract (All surgery involving the appendix or gallbladder, including any surgery relating to complications such as abscess or bile leak is excluded)
  • Non-elective hernia repair without bowel resection.
  • Minor abdominal wound dehiscence unless this causes bowel complications requiring resection
  • Ruptured ectopic pregnancy, or pelvic abscesses due to pelvic inflammatory disease
  • Laparotomy/laparoscopy for pathology caused by blunt or penetrating trauma
  • Laparotomy/laparoscopy for esophageal pathology Laparotomy/laparoscopy for pathology of the spleen, renal tract, kidneys, liver, gall bladder and biliary tree, pancreas or urinary tract

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
The change in reactive hyperemia index assessed by EndoPat
Tidsramme: The change from 4-24 hours to between day 3 and 5 after surgery
The change from 4-24 hours to between day 3 and 5 after surgery
Major adverse cardiovascular events
Tidsramme: Within 365 days of surgery
  • Cardiovascular death
  • Myocardial injury within postoperative day 3 (definition: peak plasma cardiac troponin-I ≥ 45ng/L (99th percentile URL, 10% CV at 40ng/L))
  • Acute coronary syndrome (unstable angina pectoris, NSTEMI, STEMI)
  • Congestive heart failure
  • Stroke
  • Nonfatal cardiac arrest
  • New clinically important cardiac arrhythmia
  • Coronary revascularization procedure (PCI or CABG)
  • Sudden unexpected death
Within 365 days of surgery
Postoperative non-cardiovascular complications
Tidsramme: Within 365 days of surgery
Non-cardiovascular death, sepsis, pneumonia, respiratory failure, surgical complications (min. Clavien-Dindo stage 3), Any non-cardiovascular life-threatening complication (Clavien-Dindo stage 4).
Within 365 days of surgery

Sekundære resultatmål

Resultatmål
Tidsramme
Nitric oxide biomarkers
Tidsramme: 4-24 hours after surgery and between postoperative day 3-5
4-24 hours after surgery and between postoperative day 3-5
Reactive hyperemia index assessed by EndoPat
Tidsramme: 4-24 hours after surgery
4-24 hours after surgery
Reactive hyperemia index assessed by EndoPat
Tidsramme: between day 3 and 5 after surgery
between day 3 and 5 after surgery
Blood Glucose level
Tidsramme: Postoperative day 1 - 7 (or until discharge)
Postoperative day 1 - 7 (or until discharge)
Pulmonary function
Tidsramme: Postoperative day 1 - 7 (or until discharge)
Postoperative day 1 - 7 (or until discharge)
Readmission
Tidsramme: Readmissions within 1 year of discharge
Readmissions within 1 year of discharge
Lengths of stay
Tidsramme: Lengths of stay from the operation day to discharge, on average 14 days.
Lengths of stay from the operation day to discharge, on average 14 days.
Lengths of stay in the intensive care unit
Tidsramme: Lengths of stay from the operation day to discharge from hospital, on average 14 days.
Lengths of stay from the operation day to discharge from hospital, on average 14 days.

Andre resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Postoperative quality of recovery (QoR15)
Tidsramme: postoperative day 1, 3, 5, 7, 14, 30, 90 and 365
QoR15 score
postoperative day 1, 3, 5, 7, 14, 30, 90 and 365
Numerical rating scale (NRS) pain score
Tidsramme: postoperative day 1, 3, 5, 7, 14, 30, 90 and 365
NRS pain score in rest and at activity
postoperative day 1, 3, 5, 7, 14, 30, 90 and 365
Post-Traumatic Stress Disorder
Tidsramme: postoperative day 14, 30, 90 and 365
Post-Traumatic Stress Disorder questionnaire
postoperative day 14, 30, 90 and 365
Depressive thoughts
Tidsramme: postoperative day 14, 30, 90 and 365
Hospital anxiety and depression scale
postoperative day 14, 30, 90 and 365
Postoperative pain
Tidsramme: postoperative day 14, 30, 90 and 365
Questionnaire Self-reported Leeds Assessment of Neuropatic Symptoms and Signs pain scale (S-LANSS)
postoperative day 14, 30, 90 and 365
Functional status
Tidsramme: postoperative day 14, 30, 90 and 365
Activity Assessment Scale
postoperative day 14, 30, 90 and 365

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Etterforskere

  • Hovedetterforsker: Sarah Ekeloef, MD, Department of Surgery, Zealand University Hospital
  • Hovedetterforsker: Jakob Burcharth, MD, Phd., Department of Surgery, Zealand University Hospital

Publikasjoner og nyttige lenker

Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart

1. oktober 2016

Primær fullføring (Faktiske)

1. november 2018

Studiet fullført (Faktiske)

1. november 2019

Datoer for studieregistrering

Først innsendt

16. desember 2016

Først innsendt som oppfylte QC-kriteriene

3. januar 2017

Først lagt ut (Anslag)

5. januar 2017

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

17. februar 2021

Siste oppdatering sendt inn som oppfylte QC-kriteriene

14. februar 2021

Sist bekreftet

1. februar 2021

Mer informasjon

Begreper knyttet til denne studien

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • POETRY abdominal

Plan for individuelle deltakerdata (IPD)

Planlegger du å dele individuelle deltakerdata (IPD)?

NEI

IPD-planbeskrivelse

We do not plan to share IPD

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