An investigation into the measurement and management of frailty in surgical patients
Trotter, John Martin
Thesis or dissertation
- © 2019 John Martin Trotter. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.
This thesis intends to investigate a method of identification of frailty in the surgical population, CT defined sarcopenia, and a possible method to attenuate its effects in the preoperative period, prehabilitation.
845 patients that underwent emergency laparotomy in 4 acute hospitals were screened for sarcopenia by review of CT scans assessing sarcopenia by psoas density (PD) and area (PA). Primary outcomes were 30 day and 1 year mortality.
A pilot RCT was undertaken to assess the acceptability and achievability of walking- based prehabilitation monitored by wearable technology. Participants were randomised to either normal activity or a walking based exercise programme.
Sarcopenia measured by PD was associated with increased mortality compared to non-sarcopenic patients at 30-days (23.2% vs. 9.6% p<0.0001 OR=2.84 (95% CI 1.88-4.30) and 1-year 37% vs. 19.2% p<0.0001 OR=2.46 (95% CI 1.75-3.47). Increased mortality was seen in sarcopenic patients measured by PA at 30-days (16.3% vs. 7.8% p=0.001 OR=2.31 (95% CI 1.38-3.88) and 1-year 32% vs. 18.7% p=<0.0001 OR=2.25 (95% CI 1.52-3.34)
For the RCT 45 patients were approached to recruit 40 participants. The median time in study was 12.5days (IQR 6-18). Mean compliance to the exercise programme was 58%. Mean distance change between initial and pre-operative assessment for the exercise and normal-activity groups was +16.4m and -13.6m respectively, p=0.013. Mean distance change between initial and 3-month postoperative assessment was - 11.4m and -40m p=0.11.
Sarcopenia assessed by PD and PA on CT is associated with increased mortality following emergency laparotomy. The use of sarcopenia as a predictive tool may be useful to direct geriatric input and guide expectations in emergency surgery.
This pilot study confirms that acceptable compliance can be achieved using a user- friendly pedometer and that this is associated with measurable improvements in fitness. Further work is required to establish whether this translates into improved patient outcomes after surgery.
- Hull York Medical School, The University of Hull and the University of York
- McNaught, Clare; MacFie, John; Hartley, John Edward
- Qualification level
- Qualification name
- 3 MB