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Trials
Published in: Trials 1/2015

Open Access 01-12-2015 | Study protocol

The PRECious trial PREdiction of Complications, a step-up approach, CRP first followed by CT-scan imaging to ensure quality control after major abdominal surgery: study protocol for a stepped-wedge trial

Authors: Jennifer Straatman, Miguel A. Cuesta, W. H. (Hermien) Schreurs, Boudewijn J. Dwars, Huib A. Cense, Herman Rijna, D. J. A. (Eric) Sonneveld, Frank C. den Boer, Elly S. M. de Lange- de Klerk, Donald L. van der Peet

Published in: Trials | Issue 1/2015

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Abstract

Background

After major abdominal surgery (MAS), 20 % of patients endure major complications, which require invasive treatment and are associated with increased morbidity and mortality. A quality control algorithm after major abdominal surgery aimed at early identification of patients at risk of developing major complications can decrease associated morbidity and mortality. Literature studies show promising results for C-reactive protein (CRP) as an early marker for postoperative complications, however clinical significance has yet to be determined.

Methods

A multicenter, stepped wedge, prospective clinical trial including all adult patients planned to undergo elective MAS. The first period consists of standard postoperative monitoring, which entails on demand additional examinations. This is followed by a period with implementation of postoperative control according to the PRECious protocol, which implicates standardized measurement of CRP levels. If CRP levels exceed 140 mg/L on postoperative day 3,4 or 5, an enhanced CT-scan is performed.
Primary outcome in this study is a combined primary outcome, entailing all morbidity and mortality due to postoperative complications. Complications are graded according to the Clavien-Dindo classification. Secondary outcomes are hospital length of stay, patients reported outcome measures (PROMs) and cost-effectiveness. Data will be collected during admission, three months and one year postoperatively. Approval by the medical ethics committee of the VU University Medical Center was obtained (ID 2015.114).

Discussion

the PRECious trial is a stepped-wedge, multicenter, open label, prospective clinical trial to determine the effect of a standardized postoperative quality control algorithm on postoperative morbidity and mortality, and cost-effectiveness.

Trial registration

www.ClinicalTrials.gov, NCT02102217. Registered 5 February 2015.
Appendix
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Metadata
Title
The PRECious trial PREdiction of Complications, a step-up approach, CRP first followed by CT-scan imaging to ensure quality control after major abdominal surgery: study protocol for a stepped-wedge trial
Authors
Jennifer Straatman
Miguel A. Cuesta
W. H. (Hermien) Schreurs
Boudewijn J. Dwars
Huib A. Cense
Herman Rijna
D. J. A. (Eric) Sonneveld
Frank C. den Boer
Elly S. M. de Lange- de Klerk
Donald L. van der Peet
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Trials / Issue 1/2015
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-015-0903-y

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