Patient-Centred Outcomes and Resource Utilisation After Noncardiac Surgery-D(Eutschland) (PACORUS-D)

NCT ID: NCT04675905

Last Updated: 2020-12-19

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

UNKNOWN

Total Enrollment

1200 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-02-01

Study Completion Date

2022-10-31

Brief Summary

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The PACORUS-D project aims at 1) quantifying the 30-days and 1-year disability burden (assessed using the 12-item WHODAS 2 \[WHO Disability Assessment Schedule\] questionnaire) after inhospital noncardiac nonneurosurgical procedures ; 2) quantifying the resource utilization up the 1 year after inhospital noncardiac nonneurosurgical procedures; 3) validating days alive and out of hospital (construct and criterion validity) in Germany. PACORUS-D consists of 2 independent cohort: a clinical multicentre cohort to assess "disability" and "days alive and out of hospital" and an administrative cohort to assess "days alive and out of hospital" and "resource utilization" from statutory health insurance data. PACORUS-D is intended as preparatory project in Germany before international expansion. THIS REGISTRATION REFERS TO THE CLINICAL COHORT ONLY.

Detailed Description

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Objectives:

1a) to quantify patient-reported disability measured using the 12-item WHO Disability Assessment Schedule (WHODAS) after noncardiac surgery

1. b) to assess the impact of preoperative comorbidities (and frailty in patients aged ≥65 years) and procedural risk, and of postoperative complications on 365-day patient-reported disability after noncardiac surgery;
2. a) to quantify days alive and out of hospital (DAOH), a recently proposed, integrative, easily collected and statistically-efficient outcome after noncardiac surgery;

2b) to validate (construct \[convergent\] validity) DAOH at 30 and 365 days after noncardiac surgery, i.e. to assess impact of preoperative risk factors/procedural risk and postoperative complications on DAOH; 2c) to assess in a subcohort of patients ≥ 65 years, the construct (convergent) validity of DAOH in terms of frailty (Clinical Frailty Scale);

3a) to evaluate the criterion (concurrent) validity of DAOH for patient-reported disability at 30 days and 365 days; 3b) to evaluate the criterion (predictive) validity of DAOH at 30 days for patient-reported disability at 365 days.

In addition to the main study, patients≥ 65 years may opt to participate (separate consent) to a nested cohort study to assess the impact of delirium detected by Confusion Assessment Method (CAM) on 365-day patient-reported disability after noncardiac surgery and on DAOH.

Design:

prospective multicentre cohort with nested subcohort (Delirium)

Eligibility:

Inclusion criteria:

* aged ≥50 years
* non-cardiac, non-neurosurgical surgery (thoracic, vascular, abdominal, urinary tract, or orthopaedic/trauma)
* inhospital procedure

Patients will be excluded if:

* they are unwilling or unable to provide informed consent,
* the procedure is cancelled
* they are submitted to a procedure requiring only local anesthetics or analgosedation,
* they were submitted to ≥1 surgical procedure in the 7 days prior to enrollment
* they are unable to complete the WHODAS questionnaire (e.g. language or literacy barriers);
* they were previously enrolled in PACORUS.

Endpoints:

For objectives1a-b and 3a-b, the main endpoint will be "new onset clinically significant disability" at 365 days, defined as an increase in WHODAS score of at least 5% from baseline to a final WHODAS score of at least 35% (Shulman Anesthesiology 2020).

For objectives2a-c, the main endpoint will be days alive and out of hospital. The time horizon will be 30 days (primary) and 365 days.

Additional endpoints will include "new onset clinically significant disability" at 30 days and "clinical relevant disability" at 30 and at 365 days, defined as 12-item WHODAS exceeding 35% (Shulman Anesthesiology 2020); the continuous WHODAS score at 30 days and 365 days; disability defined at 25%.

Conditions

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Noncardiac Surgery

Keywords

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Outcome Assessment, Health Care [Mesh]; Surgical Procedures, Operative, Economics noncardiac surgery disability patient-centred outcome

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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PACORUS-D Main cohort

Eligibility, Endpoints as described above

no intervention (cohort study)

Intervention Type OTHER

Explanatory variables include preoperative comorbidities, baseline disability, surgical risk, postoperative complications, sex, rural/urban area of residency, Oslo Social Support Scale; Clinical Frailty Scale in patients aged \>= 65 years

PACORUS-D Delirium-Subcohort

Eligibility: patients aged \>= 65 years undergoing noncardiac nonneurosurgical procedures (definition see above); Endpoints as described above; additional explanatory variable: postoperative Delirium detected by CAM on postoperative day 1 and 2

no intervention (cohort study)

Intervention Type OTHER

Explanatory variables include preoperative comorbidities, baseline disability, surgical risk, postoperative complications, sex, rural/urban area of residency, Oslo Social Support Scale; Clinical Frailty Scale in patients aged \>= 65 years

Interventions

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no intervention (cohort study)

Explanatory variables include preoperative comorbidities, baseline disability, surgical risk, postoperative complications, sex, rural/urban area of residency, Oslo Social Support Scale; Clinical Frailty Scale in patients aged \>= 65 years

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* aged ≥50 years
* non-cardiac, non-neurosurgical surgery (thoracic, vascular, abdominal, urinary tract, or orthopaedic/trauma)
* inhospital procedure

Patients will be excluded if:

* they are unwilling or unable to provide informed consent,
* the procedure is cancelled
* they are submitted to a procedure requiring only local anesthetics or analgosedation,
* they were submitted to ≥1 surgical procedure in the 7 days prior to enrollment
* they are unable to complete the WHODAS questionnaire (e.g. language or literacy barriers);
* they were previously enrolled in PACORUS.
Minimum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Heinrich-Heine University, Duesseldorf

OTHER

Sponsor Role collaborator

University Hospital, Bonn

OTHER

Sponsor Role collaborator

University Hospital, Aachen

OTHER

Sponsor Role collaborator

University Hospital of Cologne

OTHER

Sponsor Role collaborator

University Hospital, Essen

OTHER

Sponsor Role collaborator

University Hospital Heidelberg

OTHER

Sponsor Role collaborator

Ruhr University of Bochum

OTHER

Sponsor Role collaborator

German Society of Anesthesiology and Intensive Care (DGAI)

UNKNOWN

Sponsor Role collaborator

PD Dr. med. MSc Giovanna Lurati Buse

OTHER

Sponsor Role lead

Responsible Party

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PD Dr. med. MSc Giovanna Lurati Buse

Principal Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Giovanna AL Lurati Buse, MD, MSc

Role: PRINCIPAL_INVESTIGATOR

Anesthesiology Department, University Hospital Düsseldorf

Central Contacts

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Giovanna AL Lurati Buse, MD, MSc

Role: CONTACT

Phone: +49-211-8117828

Email: [email protected]

Other Identifiers

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PACORUS-D

Identifier Type: -

Identifier Source: org_study_id