VULNERABILITY, RESILIENCE & VASCULAR SURGERY_Version 1
Research type
Research Study
Full title
Mental vulnerability and physical resilience in vascular patients- improving their surgical experience.
IRAS ID
262106
Contact name
Julian Scott
Contact email
Sponsor organisation
Leeds teaching Hospitals NHS Trust
Duration of Study in the UK
0 years, 7 months, 9 days
Research summary
It is estimated that between 10-45% of all patients aged over 65 years admitted to hospital are frail. The modern vascular patient is now older and more susceptible to increasing levels of morbidity, frailty and mental disability. Surgical decision making can be challenging especially in this patient cohort. It has therefore become critical to establish scoring tools to identify patients who are likely to benefit from complex and costly surgical interventions to help inform patient choice and shared decision making. However, accepted strategies in assessing frailty have yet to emerge and lack clinical trial evidence. The key focus of this pilot study is to quantify the prevalence of frailty and cognitive impairment in a cohort of vascular surgery inpatients. Secondarily we aim to investigate the variability in commonly utilised methods and validated and un-validated scoring tools.
We aim to evaluate each domain of frailty: The abbreviated mental state tool is often used in clinical practice to provide a rough estimate of a patient’s cognitive function. The Montreal Cognitive Assessment (MOCA) is a more validated tool and has been shown to be associated with longer hospital stays and has been shown to be a useful tool in identifying patients who are likely to develop post-operative delirium. Delirium in itself has been associated with greater inpatient morbidity and increased costs associated with hospitalisation. The Edmonton Frailty Score (EFS) and the Addenbrookes Vascular Frailty Score (AVFS) have been previously been shown to be associated with a longer hospital stay and post-operative complications in patients aged over 60 years undergoing elective and emergency arterial intervention. The AVFS however remains an unvalidated scoring tool. The Electronic Frailty Index (eFI) has recently been launched in Leeds and scores of moderate or severe frailty now appear on in-patient IT systems. This has, however, not been validated in an in-patient surgical setting. Poor nutrition, co-morbid burden and functional performance are all aspects of frailty that are present in most frailty scoring tools. However, we aim to use the Carlson Morbidity Index, the Malnutrition Universal Screening Tool (MUST) and the Katz index of Independent Living to explore these aspects of frailty further.
This pilot project will provide data for a larger scale study and increase the awareness of clinicians and allied health professionals in the management of this complex co-morbid patient group. The study design, unlike other studies, facilitates the comparison of objective and complex measures of frailty (i.e. EFS and AVFS) to subjective and simple measures (e.g. eFI).
REC name
East of England - Essex Research Ethics Committee
REC reference
19/EE/0227
Date of REC Opinion
17 Oct 2019
REC opinion
Further Information Favourable Opinion