Continuously Iterative Perioperative Holistic Evaluation of Risk and Hypotension Prediction Index

Study Overview
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Brief Summary
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The investigators would like to explore whether Hypotension Prediction Index during and immediately after surgery can be used to improve the accuracy of scores that predict postoperative problems.

Detailed Description
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It is known that some patients have a prolonged and difficult recovery after major surgery, which impacts their long-term health and wellbeing. A major issue is that scores for predicting recovery are typically generated only once in the period before surgery, but subsequent events during and immediately after surgery can also alter the likelihood of a prolonged and difficult recovery. One such event appears to be low blood pressure (hypotension). Hypotension Prediction Index can be calculated from routine blood pressure measurements, and is an indicator of blood pressure instability. The investigators propose that Hypotension Prediction Index during and immediately after surgery may be used to improve their accuracy of scores that predict postoperative problems. To explore this, the investigators will collect information about the health and care needs, surgery and postoperative recovery of adult patients' requiring major surgery. This data will be taken from hospital information systems, a bedside monitor, test reports, a questionnaire and National Databases. The investigators will then use statistical models to determine whether Hypotension Prediction Index improves the accuracy of preoperative scores for predicting postoperative problems. Ultimately, the investigators hope to create a tool for predicting how well a patient will recover based on the information available at any given point in time. Healthcare professionals will be able to use this tool to identify and support the needs of patients who need extra help recovering from major surgery.

Official Title
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Continuously Iterative Perioperative Holistic Evaluation of Risk and Hypotension Prediction Index

Conditions
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Surgery--Complications

Intervention / Treatment
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* Device: Hypotension Prediction Index


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who: are referred for CPET are scheduled for elective surgery and expected to have >24 hours postoperative hospital stay will receive invasive arterial pressure monitoring as part of routine care are aged 18 or over have the capacity to give consent to participate Exclusion Criteria: Patients who: do not proceed to surgery following CPET referral are aged less than 18 years do not have capacity to consent decline to consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Device: Hypotension Prediction Index|HemoSphere Clinical Platform with Acumen Hypotension Prediction Index Feature|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Days alive and out of hospital | Number of days that the participant is alive and out of hospital | Day 30 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Morbidity | Whether or not a participant has morbidity as measured using the post operative morbidity survey | Day 5 | 
| Complications | Whether or not a participant develops complications as measured using Clavien Dindo | From the date and time of surgery until hospital discharge | 
| Number of nights that a participant spends at home |  | Day 30 and 90 | 
| Mortality | Number of participants who die within 30 days or 1 year of surgery | Day 30 and 1 year | 
| Quality of Recovery - 15 score (QoR-15) | A 15 question survey, where a number of different items are scored on a 10 point numeric scale. Higher scores represent better outcomes as reported by the participant | Day 90 | 
| Return to pre-surgery functioning | Participants ability to return to work or usual home activities as measured by item 8 of the Quality of Recovery - 15 score. This will be scored on a 10 point numeric scale. Higher scores represent better outcomes as reported by the patient. | Day 90 | 
| Total length of critical care stay | Number of nights spent in Critical Care | First 30 days after surgery | 
| Hospital length of stay | Number of nights spent in hospital | Between the date of surgery and hospital discharge (primary admission) | 
| Hospital readmission | Readmission to hospital following discharge | 30 days | 
| Total length of hospital stay | Number of nights spent in hospital | 30 days | 
| Reoperation | Number of unplanned operations | Day 30 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Perioperative medicine, Risk, Predictive analytics, Hypotension Prediction Index, Observational cohort