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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT04978285
Registration number
NCT04978285
Ethics application status
Date submitted
16/07/2021
Date registered
27/07/2021
Titles & IDs
Public title
Association of Postoperative Anaemia With Patient-centred Outcomes
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Scientific title
Association of Postoperative Anaemia With Patient-centred Outcomes
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Secondary ID [1]
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544/12
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Anemia After Surgery
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Condition category
Condition code
Blood
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Anaemia
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Intervention/exposure
Study type
Observational
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Patient registry
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
Other interventions - Anemia
Postoperative anemia - All patients enrolled in the RELIEF trial in which a postoperative Day 1-3 hemoglobin concentration was measured. Anaemia will be defined according to the World Health Organisation definition (males Hb \<130 g/L, and female Hb \<120 g/L).
No postoperative anemia - All patients enrolled in the RELIEF trial in which a postoperative Day 1-3 hemoglobin concentration was measured. No anaemia will be defined according to the World Health Organisation definition (males Hb =130 g/L, and females Hb =120 g/L).
Other interventions: Anemia
Depends on Day 3 Hb result
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Intervention code [1]
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Other interventions
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Persistent disability or death by 90 days
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Assessment method [1]
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Defined as a World Health Organization Disability Assessment Schedule 2.0 (WHODAS) score of at least 24 points (on the 48-point scale) at both 30 and 90 days postoperatively, reflecting a disability level of at least 25% and being the threshold point between "disabled" and "not disabled" as per WHO guidelines. Disability was assessed by the participant, but if unable then we used the proxy's report.
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Timepoint [1]
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90 days after surgery
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Secondary outcome [1]
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Death: all-cause mortality at 90 days, then up to 12 months after surgery
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Assessment method [1]
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Timepoint [1]
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1 year
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Secondary outcome [2]
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A composite (pooled) and individual septic complications: sepsis, surgical site infection, anastomotic leak, and pneumonia
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Assessment method [2]
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Timepoint [2]
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30 days
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Secondary outcome [3]
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Sepsis: using Centers for Disease Control and Prevention (CDC) with National Healthcare Safety Network (NHSN) criteria
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Assessment method [3]
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0
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Timepoint [3]
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30 days
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Secondary outcome [4]
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Surgical site infection
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Assessment method [4]
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CDC criteria
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Timepoint [4]
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30 days
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Secondary outcome [5]
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Pneumonia
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Assessment method [5]
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The presence of new and/or progressive pulmonary infiltrates on chest radiograph plus two or more of the following:
i. Fever = 38.5°C or postoperative hypothermia \<36°C ii. Leucocytosis = 12,000 WBC/mm3 or leucopenia \< 4,000 WBC/mm3 iii. Purulent sputum and/or iv. New onset or worsening cough or dyspnea.
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Timepoint [5]
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30 days
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Secondary outcome [6]
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Anastomotic leak
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Assessment method [6]
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A defect of the intestinal wall at the anastomotic site (including suture and staple lines of neorectal reservoirs) leading to a communication between the intra- an extra luminal compartments.
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Timepoint [6]
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30 days
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Secondary outcome [7]
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Acute kidney injury
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Assessment method [7]
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According to The Kidney Disease: Improving Global Outcomes (KDIGO) group criteria, but not urine output - for Stage 2 or worse AKI defined as at least 2-fold increase in creatinine, or estimated GFR decrease \>50%
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Timepoint [7]
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30 days
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Secondary outcome [8]
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Unplanned admission to ICU within 30 days of surgery
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Assessment method [8]
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Timepoint [8]
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30 days
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Secondary outcome [9]
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ICU stay
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Assessment method [9]
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Total days - additive, including initial ICU admission and readmission times up to Day 30
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Timepoint [9]
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30 days
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Secondary outcome [10]
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Hospital stay
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Assessment method [10]
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Total -additive, from the start (date, time) of surgery until actual hospital discharge , plus readmission(s) up to Day 30
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Timepoint [10]
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30 days
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Secondary outcome [11]
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Quality of recovery
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Assessment method [11]
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QoR-15 scale score
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Timepoint [11]
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Postoperative Days 3 and 30
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Secondary outcome [12]
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Hospital re-admission
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Assessment method [12]
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Timepoint [12]
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At 3, 6 and 12 months.
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Eligibility
Key inclusion criteria
1. Adults (=18 years) undergoing elective major surgery and providing informed consent
2. All types of open or lap-assisted abdominal or pelvic surgery with an expected duration of at least 2 hours, and an expected hospital stay of at least 3 days
3. At increased risk of postoperative complications, as defined by any of the following criteria:
1. age =70 years
2. known or documented history of coronary artery disease
3. known or documented history of heart failure
4. diabetes currently treated with an oral hypoglycemic agent and/or insulin
5. preoperative serum creatinine >200 micromol/L (>2.8 mg/dl)
6. morbid obesity (BMI =35 kg/m2)
7. preoperative serum albumin <30 g/L
8. anaerobic threshold (if done) <12 mL/kg/min
9. or two or more of the following risk factors:
* ASA 3 or 4
* chronic respiratory disease
* obesity (BMI 30-35 kg/m2)
* aortic or peripheral vascular disease
* preoperative Hb <100 g/L
* preoperative serum creatinine 150-199 micromol/L (>1.7 mg/dl)
* anerobic threshold (if done) 12-14 mL/kg/min
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Urgent or time-critical surgery
2. ASA physical status 5 - such patients are not expected to survive with or without surgery, and their underlying illness is expected to have an overwhelming effect on outcome (irrespective of fluid therapy)
3. Chronic renal failure requiring dialysis
4. Pulmonary or cardiac surgery - different pathophysiology, and thoracic surgery typically have strict fluid restrictions
5. Liver resection - most units have strict fluid/CVP limits in place and won't allow randomisation
6. Minor or intermediate surgery, such as laparoscopic cholecystectomy, transurethral resection of the prostate, inguinal hernia repair, splenectomy, closure of colostomy - each of these are typically "minor" surgery with minimal IV fluid requirements, generally low rates of complications and mostly very good survival.
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Study design
Purpose
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Duration
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Selection
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Timing
Retrospective
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
16/07/2021
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
30/11/2021
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Sample size
Target
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Accrual to date
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Final
3000
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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Alfred Hospital - Melbourne
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Recruitment postcode(s) [1]
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3004 - Melbourne
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Funding & Sponsors
Primary sponsor type
Government body
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Name
Bayside Health
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Address
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Country
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Other collaborator category [1]
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Other
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Name [1]
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Monash University
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Address [1]
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Country [1]
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Ethics approval
Ethics application status
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Summary
Brief summary
Primary aim - To investigate the relationship between postoperative anaemia and patient-centred outcomes after major abdominal surgery. Secondary aim - To determine whether a more liberal perioperative IV fluid strategy increases the risk of postoperative anaemia (haemodilution). Hypothesis: Adults with anaemia in the immediate postoperative period following major abdominal surgery have a poorer quality of recovery and higher risk of complications, leading to poor disability-free survival when compared with patients without postoperative anaemia.
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Trial website
https://clinicaltrials.gov/study/NCT04978285
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Trial related presentations / publications
Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, Christophi C, Leslie K, McGuinness S, Parke R, Serpell J, Chan MTV, Painter T, McCluskey S, Minto G, Wallace S; Australian and New Zealand College of Anaesthetists Clinical Trials Network and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. N Engl J Med. 2018 Jun 14;378(24):2263-2274. doi: 10.1056/NEJMoa1801601. Epub 2018 May 9. Myles PS, Richards T, Klein A, Wood EM, Wallace S, Shulman MA, Martin C, Bellomo R, Corcoran TB, Peyton PJ, Story DA, Leslie K, Forbes A; RELIEF Trial Investigators. Postoperative anaemia and patient-centred outcomes after major abdominal surgery: a retrospective cohort study. Br J Anaesth. 2022 Sep;129(3):346-354. doi: 10.1016/j.bja.2022.06.014. Epub 2022 Jul 15.
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Undecided
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No/undecided IPD sharing reason/comment
Consider, on request
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What supporting documents are/will be available?
No Supporting Document Provided
Type
Other Details
Attachment
Study protocol
https://cdn.clinicaltrials.gov/large-docs/85/NCT04978285/Prot_000.pdf
Statistical analysis plan
https://cdn.clinicaltrials.gov/large-docs/85/NCT04978285/SAP_001.pdf
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT04978285