Intermediate Care - Effect on Mortality Following Emergency Abdominal Surgery

NCT ID: NCT01209663

Last Updated: 2015-06-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

286 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-10-31

Study Completion Date

2012-12-31

Brief Summary

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The objective of this trial is to evaluate postoperative intermediate care versus ward care in patients who have undergone emergency abdominal surgery with a perioperative Acute Physiology and Chronic Health Evaluation (APACHE) II score ≥ 10 (high risk patients).

Patients will be enrolled in the trial, if they are ready to be discharged from the recovery unit or intensive/intermediate care unit to the surgical ward within 24 hours after surgery. Discharge criteria will be according to the Danish national recommendation.

The intermediate care bed in the trial is defined by a certain minimum requirements to patient observation and described treatment possibilities which have to be available to the intermediate bed. If the treatment exceeds these treatment possibilities, the patient will be classified as an intensive care patient. The intermediate care bed will be placed at an intensive care unit, recovery unit or a surgical high dependency unit. If there is no available intermediate care bed, the patients will not be randomized, but only registered as "excluded because of no available intermediate care bed".

Hypothesis: Postoperative intermediate care for 48 hours or more will reduce the 30-day mortality in emergency abdominal surgery patients with a high risk of postoperative organ failure.

Interim analysis: An independent Data Monitoring and Safety Committee (DMSC) will conducted the interim analysis based on the analysis of the primary outcome blinded for intervention allocation. The DMSC will use P\<0.001 (Haybittle-Peto) on two subsequent interim analyses as the statistical limit to guide its recommendations regarding early termination of the trial for benefit or harm. The first interim analysis will be conducted when the 30 days follow-up data of about 50% (i.e., about 200 patients) of the trial participants have been obtained and/or 75 deaths have been documented during the trial. If P\<0,001 in the first interim analysis a second interim analysis will be conducted when the 30 days follow-up data of about 75% (i.e., about 300 patients) of the trial participants have been obtained and/or 25 deaths have been documented during the trial.

Trial terminated on the 30th November 2012. The Data Monitor Committee found a very low overall event rate of the primary outcome at the first interim-analysis as compared to the pre-trial estimated. This precluding any possibility to detect or reject the anticipated relative risk reduction of 34 % as used in the sample size estimation.

Detailed Description

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Like Denmark, many European countries has only limited access to surgical intermediate care beds (high dependency beds). This may reflect lack of scientific evidence for the effect of intermediate care combined with restricted healthcare resources. Better access to dedicated postoperative intensive/intermediate care facilities has been suggested as a factor which potentially can reduce postoperative complication rate and mortality in high risk surgical patients. The Incare Trial will provide important data on the effect of postoperative intermediate care in emergency abdominal surgery patients.

Conditions

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Emergency Abdominal Surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Ward Care

Protocol based discharge to the surgery ward. Observation and treatment is conducted by ward nurses and general surgeons (current treatment).

Group Type ACTIVE_COMPARATOR

Postoperative Intermediate Care

Intervention Type OTHER

Comparison of postoperative Intermediate Care versus Ward Care.

Intermediate Care

Observation and treatment in an intermediate care bed in a minimum of 48 hours after randomization. Daily rounds will be carried out by both general surgeons and intensive care physicians.

Group Type EXPERIMENTAL

Postoperative Intermediate Care

Intervention Type OTHER

Comparison of postoperative Intermediate Care versus Ward Care.

Interventions

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Postoperative Intermediate Care

Comparison of postoperative Intermediate Care versus Ward Care.

Intervention Type OTHER

Other Intervention Names

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High dependency bed High dependency unit

Eligibility Criteria

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Inclusion Criteria

* Emergency laparotomy patients treated by general surgeons OR
* Emergency laparoscopic surgery patients treated by general surgeons OR
* Re-operative patients who go through emergency laparotomy or laparoscopy.

AND

* APACHE II score ≥ 10 AND
* Patients who are ready to be discharged to the surgical ward after postoperative stay in the recovering unit or an intermediate/intensive care bed

Exclusion Criteria

* Appendectomy
* Emergency laparoscopic cholecystectomy
* Emergency diagnostic laparoscopy without intervention
* Postoperative stay in the recovery unit or an intermediate/intensive care bed in more then 24 hours before randomization
* Patients who should not be offered postoperative intensive care
* Patients who have been included in the study earlier
* Age \< 18 years
* Trauma patients
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Copenhagen

OTHER

Sponsor Role collaborator

Copenhagen Trial Unit, Center for Clinical Intervention Research

OTHER

Sponsor Role collaborator

Herlev Hospital

OTHER

Sponsor Role collaborator

Sygekassernes Helsefond

OTHER

Sponsor Role collaborator

Danish Council for Independent Research

OTHER

Sponsor Role collaborator

AP Moeller Foundation

OTHER

Sponsor Role collaborator

Lundbeck Foundation

OTHER

Sponsor Role collaborator

Hilleroed Hospital

UNKNOWN

Sponsor Role collaborator

Zealand University Hospital

OTHER

Sponsor Role collaborator

Bispebjerg Hospital

OTHER

Sponsor Role collaborator

Herning Hospital

OTHER

Sponsor Role collaborator

Aabenraa Hospital

OTHER

Sponsor Role collaborator

Vejle Hospital

OTHER

Sponsor Role collaborator

Copenhagen University Hospital at Herlev

OTHER

Sponsor Role lead

Responsible Party

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Morten Vester-Andersen

MD, Senior resident

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Morten Vester-Andersen, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Herlev

Ann M Møller, MD, PhD

Role: STUDY_CHAIR

Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Herlev

Jørn Wetterslev, MD, PhD

Role: STUDY_CHAIR

Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Rigshospitalet

Jacob Rosenberg, MD, Prof

Role: STUDY_CHAIR

Department of Gastrointestinal Surgery, Copenhagen University Hospital Herlev

Tina Waldau, MD, PhD

Role: STUDY_CHAIR

Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Herlev

Morten H Møller, MD, PhD

Role: STUDY_CHAIR

Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Bispebjerg

Flemming Moesgaard, MD, PhD

Role: STUDY_CHAIR

Department of Gastrointestinal Surgery, Copenhagen University Hospital Herlev

Lars N Jørgensen, MD, Prof.

Role: STUDY_CHAIR

Department of Gastrointestinal Surgery, Copenhagen University Hospital Bispebjerg

Locations

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Copenhagen University, Bispebjerg Hospital

Copenhagen, DK, Denmark

Site Status

Herning Regional Hospital

Herning, DK, Denmark

Site Status

Aabenraa Hospital

Aabenraa, , Denmark

Site Status

Herlev University Hospital

Copenhagen, , Denmark

Site Status

Copehagen University, Hilleroed Hospital

Hilleroed, , Denmark

Site Status

Copenhagen University, Koege Hospital

Koege, , Denmark

Site Status

Sygehus Lillebaelt, Vejle Hospital

Vejle, , Denmark

Site Status

Countries

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Denmark

References

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Vester-Andersen M, Waldau T, Wetterslev J, Moller MH, Rosenberg J, Jorgensen LN, Jakobsen JC, Moller AM; InCare trial group. Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial). Br J Surg. 2015 May;102(6):619-29. doi: 10.1002/bjs.9749. Epub 2015 Mar 18.

Reference Type DERIVED
PMID: 25789827 (View on PubMed)

Vester-Andersen M, Waldau T, Wetterslev J, Moller MH, Rosenberg J, Jorgensen LN, Gillesberg I, Jakobsen HL, Hansen EG, Poulsen LM, Skovdal J, Sogaard EK, Bestle M, Vilandt J, Rosenberg I, Berthelsen RE, Pedersen J, Madsen MR, Feurstein T, Busse MJ, Andersen JD, Maschmann C, Rasmussen M, Jessen C, Bugge L, Ording H, Moller AM. Effect of intermediate care on mortality following emergency abdominal surgery. The InCare trial: study protocol, rationale and feasibility of a randomised multicentre trial. Trials. 2013 Feb 2;14:37. doi: 10.1186/1745-6215-14-37.

Reference Type DERIVED
PMID: 23374977 (View on PubMed)

Other Identifiers

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H-3-2010-010

Identifier Type: -

Identifier Source: org_study_id

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