Functional Improvement Trajectories After Surgery (FIT After Surgery) study: protocol for a multicentre prospective cohort study to evaluate significant new disability after major surgery in older adults
Introduction Older adults prioritise surviving surgery, but also preservation of their functional status and quality of life. Current approaches to measure postoperative recovery, which focus on death, complications and length of hospitalisation, may miss key relevant domains. We propose that postop...
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e062524.full |
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| author | E Jacobsohn Duminda N Wijeysundera Gerald Lebovic M Davis Martine T E Puts Shabbir M H Alibhai Karim S Ladha C Wong Daniel I McIsaac C Hanley T Barnes G Lorello N Siddiqui P Serrano Tyler R Chesney S Choi J Van Vlymen D Sussman D Macdonald P Jüni Emily Hladkowicz C David Mazer M Bosch CD Mazer A Jerath J Pazmino-Canizares E Kennedy R Spence V Lyon Alice C Wei Julian F Daza Sahar Ehtesham Janet M van Vlymen DN Wijeysundera KS Ladha JF Daza G Mattina E Hladkowicz M Tessier S Ehtesham S Nnorom SMH Alibhai M Puts G Lebovic TR Chesney AC Wei S Drozdz M Louridas RH Breau M Lalu S Abdellatif S Gagne E Duceppe K Zarnke D Dumerton M Karizhenskaia H El Beheiry F Bonazza A Zahavich M Thorleifson S L Russell H Bagry SY MacDonell J Dale-Gandar L Kaustov A Fleet E Al Azazi M Parotto S A McCluskey H Poonawala D Dillane Di McIsaac S Avramescu S Shabeen |
| author_facet | E Jacobsohn Duminda N Wijeysundera Gerald Lebovic M Davis Martine T E Puts Shabbir M H Alibhai Karim S Ladha C Wong Daniel I McIsaac C Hanley T Barnes G Lorello N Siddiqui P Serrano Tyler R Chesney S Choi J Van Vlymen D Sussman D Macdonald P Jüni Emily Hladkowicz C David Mazer M Bosch CD Mazer A Jerath J Pazmino-Canizares E Kennedy R Spence V Lyon Alice C Wei Julian F Daza Sahar Ehtesham Janet M van Vlymen DN Wijeysundera KS Ladha JF Daza G Mattina E Hladkowicz M Tessier S Ehtesham S Nnorom SMH Alibhai M Puts G Lebovic TR Chesney AC Wei S Drozdz M Louridas RH Breau M Lalu S Abdellatif S Gagne E Duceppe K Zarnke D Dumerton M Karizhenskaia H El Beheiry F Bonazza A Zahavich M Thorleifson S L Russell H Bagry SY MacDonell J Dale-Gandar L Kaustov A Fleet E Al Azazi M Parotto S A McCluskey H Poonawala D Dillane Di McIsaac S Avramescu S Shabeen |
| collection | DOAJ |
| description | Introduction Older adults prioritise surviving surgery, but also preservation of their functional status and quality of life. Current approaches to measure postoperative recovery, which focus on death, complications and length of hospitalisation, may miss key relevant domains. We propose that postoperative disability is an important patient-centred outcome to measure intermediate-to-long recovery after major surgery in older adults.Methods and analysis The Functional Improvement Trajectories After Surgery (FIT After Surgery) study is a multicentre cohort study of 2000 older adults (≥65 years) having major non-cardiac surgery. Its objectives are to characterise the incidence, trajectories, risk factors and impact of new significant disability after non-cardiac surgery. Disability is assessed using WHO Disability Assessment Schedule (WHODAS) 2.0 instrument and participants’ level-of-care needs. Disability assessments occur before surgery, and at 1, 3, 6, 9 and 12 months after surgery. The primary outcome is significantly worse WHODAS score or death at 6 months after surgery. Secondary outcomes are (1) significantly worse WHODAS score or death at 1 year after surgery, (2) increased care needs or death at 6 months after surgery and (3) increased care needs or death at 1 year after surgery. We will use multivariable logistic regression models to determine the association of preoperative characteristics and surgery type with outcomes, joint modelling to characterise longitudinal time trends in WHODAS scores over 12 months after surgery, and longitudinal latent class mixture models to identify clusters following similar trajectories of disability.Ethics and dissemination The FIT After Surgery study has received research ethics board approval at all sites. Recruitment began in December 2019 but was placed on hold in March 2020 because of the COVID-19 pandemic. Recruitment was gradually restarted in October 2020, with 1-year follow-up expected to finish in 2023. Publication of the primary results is anticipated to occur in 2024. |
| format | Article |
| id | doaj-art-cb9262bd0ed341dd94dacd9c64c0bcb5 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-cb9262bd0ed341dd94dacd9c64c0bcb52025-01-24T01:55:08ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2022-062524Functional Improvement Trajectories After Surgery (FIT After Surgery) study: protocol for a multicentre prospective cohort study to evaluate significant new disability after major surgery in older adults E JacobsohnDuminda N Wijeysundera0Gerald Lebovic1M Davis2Martine T E Puts3Shabbir M H Alibhai4Karim S Ladha5C WongDaniel I McIsaac6C HanleyT BarnesG LorelloN SiddiquiP SerranoTyler R Chesney7S ChoiJ Van VlymenD SussmanD MacdonaldP JüniEmily Hladkowicz8C David Mazer9M BoschCD MazerA JerathJ Pazmino-CanizaresE KennedyR SpenceV LyonAlice C Wei10Julian F Daza11Sahar Ehtesham12Janet M van Vlymen13DN Wijeysundera14KS LadhaJF DazaG MattinaE HladkowiczM TessierS EhteshamS NnoromSMH AlibhaiM PutsG LebovicTR ChesneyAC WeiS DrozdzM LouridasRH BreauM LaluS AbdellatifS GagneE DuceppeK ZarnkeD DumertonM KarizhenskaiaH El BeheiryF BonazzaA ZahavichM ThorleifsonS L RussellH BagrySY MacDonellJ Dale-GandarL KaustovA FleetE Al AzaziM ParottoS A McCluskeyH PoonawalaD DillaneDi McIsaacS AvramescuS Shabeen4 Anesthesia, University of Toronto Faculty of Medicine, Toronto, Ontario, CanadaInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada3Medicus Economics, LLC, MiltonLawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, CanadaDepartment of Medicine, University Health Network, Toronto, Ontario, Canada1 Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, CanadaanaesthesiologistDepartment of Surgery, Division of General Surgery, University of Toronto, Toronto, Ontario, Canada6 Departments of Anaesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, CanadaDepartment of Anesthesia, St. Michael`s Hospital, Toronto, Ontario, CanadaDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USADepartment of Surgery, Division of General Surgery, University of Toronto, Toronto, Ontario, CanadaApplied Health Research Centre, St Michael`s Hospital, Toronto, Ontario, CanadaDepartment of Anesthesiology and Perioperative Medicine, Queen`s University, Kingston, Ontario, Canada3Anesthesia, University of Toronto, Toronto, CanadaIntroduction Older adults prioritise surviving surgery, but also preservation of their functional status and quality of life. Current approaches to measure postoperative recovery, which focus on death, complications and length of hospitalisation, may miss key relevant domains. We propose that postoperative disability is an important patient-centred outcome to measure intermediate-to-long recovery after major surgery in older adults.Methods and analysis The Functional Improvement Trajectories After Surgery (FIT After Surgery) study is a multicentre cohort study of 2000 older adults (≥65 years) having major non-cardiac surgery. Its objectives are to characterise the incidence, trajectories, risk factors and impact of new significant disability after non-cardiac surgery. Disability is assessed using WHO Disability Assessment Schedule (WHODAS) 2.0 instrument and participants’ level-of-care needs. Disability assessments occur before surgery, and at 1, 3, 6, 9 and 12 months after surgery. The primary outcome is significantly worse WHODAS score or death at 6 months after surgery. Secondary outcomes are (1) significantly worse WHODAS score or death at 1 year after surgery, (2) increased care needs or death at 6 months after surgery and (3) increased care needs or death at 1 year after surgery. We will use multivariable logistic regression models to determine the association of preoperative characteristics and surgery type with outcomes, joint modelling to characterise longitudinal time trends in WHODAS scores over 12 months after surgery, and longitudinal latent class mixture models to identify clusters following similar trajectories of disability.Ethics and dissemination The FIT After Surgery study has received research ethics board approval at all sites. Recruitment began in December 2019 but was placed on hold in March 2020 because of the COVID-19 pandemic. Recruitment was gradually restarted in October 2020, with 1-year follow-up expected to finish in 2023. Publication of the primary results is anticipated to occur in 2024.https://bmjopen.bmj.com/content/12/6/e062524.full |
| spellingShingle | E Jacobsohn Duminda N Wijeysundera Gerald Lebovic M Davis Martine T E Puts Shabbir M H Alibhai Karim S Ladha C Wong Daniel I McIsaac C Hanley T Barnes G Lorello N Siddiqui P Serrano Tyler R Chesney S Choi J Van Vlymen D Sussman D Macdonald P Jüni Emily Hladkowicz C David Mazer M Bosch CD Mazer A Jerath J Pazmino-Canizares E Kennedy R Spence V Lyon Alice C Wei Julian F Daza Sahar Ehtesham Janet M van Vlymen DN Wijeysundera KS Ladha JF Daza G Mattina E Hladkowicz M Tessier S Ehtesham S Nnorom SMH Alibhai M Puts G Lebovic TR Chesney AC Wei S Drozdz M Louridas RH Breau M Lalu S Abdellatif S Gagne E Duceppe K Zarnke D Dumerton M Karizhenskaia H El Beheiry F Bonazza A Zahavich M Thorleifson S L Russell H Bagry SY MacDonell J Dale-Gandar L Kaustov A Fleet E Al Azazi M Parotto S A McCluskey H Poonawala D Dillane Di McIsaac S Avramescu S Shabeen Functional Improvement Trajectories After Surgery (FIT After Surgery) study: protocol for a multicentre prospective cohort study to evaluate significant new disability after major surgery in older adults BMJ Open |
| title | Functional Improvement Trajectories After Surgery (FIT After Surgery) study: protocol for a multicentre prospective cohort study to evaluate significant new disability after major surgery in older adults |
| title_full | Functional Improvement Trajectories After Surgery (FIT After Surgery) study: protocol for a multicentre prospective cohort study to evaluate significant new disability after major surgery in older adults |
| title_fullStr | Functional Improvement Trajectories After Surgery (FIT After Surgery) study: protocol for a multicentre prospective cohort study to evaluate significant new disability after major surgery in older adults |
| title_full_unstemmed | Functional Improvement Trajectories After Surgery (FIT After Surgery) study: protocol for a multicentre prospective cohort study to evaluate significant new disability after major surgery in older adults |
| title_short | Functional Improvement Trajectories After Surgery (FIT After Surgery) study: protocol for a multicentre prospective cohort study to evaluate significant new disability after major surgery in older adults |
| title_sort | functional improvement trajectories after surgery fit after surgery study protocol for a multicentre prospective cohort study to evaluate significant new disability after major surgery in older adults |
| url | https://bmjopen.bmj.com/content/12/6/e062524.full |
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