- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT05250882
Enhanced Perioperative Care for the Prevention of Colorectal Anastomotic Leakage (DOUBLE CHECK)
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
Studieoversikt
Status
Forhold
Intervensjon / Behandling
Detaljert 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.
Studietype
Registrering (Forventet)
Fase
- Ikke aktuelt
Kontakter og plasseringer
Studiesteder
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-
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Antwerpen, Belgia
- UZA
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-
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Limburg
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Helmond, Limburg, Nederland
- Elkerliek
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Maastricht, Limburg, Nederland
- Maastricht UMC+
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Noord Brabant
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Den Bosch, Noord Brabant, Nederland
- Jeroen Bosch Ziekenhuis
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Uden, Noord Brabant, Nederland
- Bernhoven
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Veldhoven, Noord Brabant, Nederland
- Maxima Medisch Centrum
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Noord Holland
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Amsterdam, Noord Holland, Nederland
- Amsterdam UMC
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Hoorn, Noord Holland, Nederland
- Dijklander ziekenhuis
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Zeeland
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Terneuzen, Zeeland, Nederland
- ZorgSaam
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Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
- Barn
- Voksen
- Eldre voksen
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
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
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Ikke-randomisert
- Intervensjonsmodell: Crossover-oppdrag
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
---|---|
Eksperimentell: 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.
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See arm/group description
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Ingen inngripen: 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.
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Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Number of modifiable intraoperative CAL risk factors present during surgery as assessed by the DoubleCheck list
Tidsramme: Intraoperative phase
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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:
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
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Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Colorectal anastomotic leakage (CAL)
Tidsramme: 30 days after surgery
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Defined as a grade B or C according to the ISREC classification
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30 days after surgery
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Postoperative complications
Tidsramme: 30 days after surgery
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Defined as any adverse event occurring in the postoperative period until 30 days after surgery and graded according to the Dindo-Clavien classification
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30 days after surgery
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Postoperative mortality
Tidsramme: 30 days after surgery
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Measured as rate of death at 30-day follow-up
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30 days after surgery
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Hospital Stay
Tidsramme: 30 days after surgery
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Length of hospital and intensive care unit stay
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30 days after surgery
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Readmission
Tidsramme: 30 days after surgery
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30-day readmission rate
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30 days after surgery
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Samarbeidspartnere og etterforskere
Sponsor
Publikasjoner og nyttige lenker
Generelle publikasjoner
- Huisman DE, Reudink M, van Rooijen SJ, Bootsma BT, van de Brug T, Stens J, Bleeker W, Stassen LPS, Jongen A, Feo CV, Targa S, Komen N, Kroon HM, Sammour T, Lagae EAGL, Talsma AK, Wegdam JA, de Vries Reilingh TS, van Wely B, van Hoogstraten MJ, Sonneveld DJA, Veltkamp SC, Verdaasdonk EGG, Roumen RMH, Slooter GD, Daams F. LekCheck: A Prospective Study to Identify Perioperative Modifiable Risk Factors for Anastomotic Leakage in Colorectal Surgery. Ann Surg. 2022 Jan 1;275(1):e189-e197. doi: 10.1097/SLA.0000000000003853.
- van Rooijen SJ, Huisman D, Stuijvenberg M, Stens J, Roumen RMH, Daams F, Slooter GD. Intraoperative modifiable risk factors of colorectal anastomotic leakage: Why surgeons and anesthesiologists should act together. Int J Surg. 2016 Dec;36(Pt A):183-200. doi: 10.1016/j.ijsu.2016.09.098. Epub 2016 Oct 15. Review.
Studierekorddatoer
Studer hoveddatoer
Studiestart (Faktiske)
Primær fullføring (Forventet)
Studiet fullført (Forventet)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Faktiske)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- 2020.0634
Plan for individuelle deltakerdata (IPD)
Planlegger du å dele individuelle deltakerdata (IPD)?
IPD-planbeskrivelse
IPD-delingstidsramme
Tilgangskriterier for IPD-deling
Legemiddel- og utstyrsinformasjon, studiedokumenter
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