Accepted for/Published in: JMIR Research Protocols
Date Submitted: Oct 30, 2019
Date Accepted: Mar 24, 2021
The association of post-operative clinical outcomes with sarcopenia, frailty, and nutritional status in older colorectal cancer patients: A prospective cohort study protocol
ABSTRACT
Background:
Older patients account for a significant proportion of patients undergoing colorectal cancer surgery and are vulnerable to a number of pre-operative risk factors that are not often present in younger patients. Three pre-operative risk factors more prevalent in the elderly are frailty, sarcopenia, and malnutrition. Whilst each of these has been studied in isolation, there is little information on the interplay between them in older surgical patients. One particular area of increasing interest is the use of urine metabolomics for objective evaluation of dietary profiles and malnutrition.
Objective:
Herein we describe the design, cohort, and standard operating procedures of a planned prospective study of older surgical patients undergoing colorectal cancer resection across multiple institutions in the United Kingdom. The objectives are to determine the association between clinical outcomes and frailty, nutritional status and sarcopenia.
Methods:
These procedures include serial frailty evaluations (Clinical Frailty Scale and Groningen Frailty Indicator), functional assessments (with hand grip strength and 4-metre walk test), muscle mass evaluations using computerized tomography morphometric analysis, and evaluation of nutritional status using analysis of urinary dietary biomarkers.
Results:
The primary feasibility outcome is to estimate the incidence rate of post-operative complications, and the primary clinical outcome is to associate the presence of post-operative complications with frailty, sarcopenia and nutritional status. The secondary outcome measures are length of hospital stay, 30-day hospital readmission and mortality at days 30 and 90.
Conclusions:
As frailty, sarcopenia and malnutrition are all areas of common derangement in the elderly surgical population, prospectively studying them in concert will allow for analysis of their interplay as well as the development of predictive models for those at risk of commonly tracked surgical complications and outcomes.
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