Learn more about the study
Background and study rationale
The number of older people undergoing surgery globally is increasing due to demographic changes and improvements in surgical and perioperative care. The population of older people include some who are frail, have multiple comorbidities, and/or are at risk of postoperative delirium.
A key question for researchers, clinicians, those responsible for planning perioperative services, and most importantly, patients and their families, is therefore, how to identify frailty and risk of delirium in routine clinical settings, what to do with frailty, multimorbidity and delirium risk in the time before surgery, and how these conditions should be managed during and after surgery. This study will aim to generate a large, high-quality dataset on a cohort of older people undergoing a range of surgical procedures to help address these questions.
It is not possible for this study to answer every question about surgery, frailty, multimorbidity and delirium. This study’s main focus is on the impact and management of frailty but will attempt to answer key questions about postoperative delirium.
Learn more about the goals
Objectives
Primary Objective:
• To characterise the epidemiology of frailty, multimorbidity and postoperative delirium in older people undergoing surgery in the UK, Australia, and New Zealand.
Secondary Objectives:
• Examine the relationship between frailty and perioperative outcomes separately by surgery types
• Examine the relationship between multimorbidity and perioperative outcomes separately by surgery types
• Examine the relationship between frailty and multimorbidity in the older person undergoing surgery
• Describe the variation in hospital-level and patient-level frailty-related interventions
• Identify associations between hospital-level and patient-level frailty-related interventions and outcome
• Develop and internally validate a risk-prediction tool for postoperative delirium
Study configuration
Multicentre, prospective snapshot observational cohort study.
The project will involve three parallel studies:
• S1) Prospective, observational cohort study
• S2) Organisational survey of current pathways of pre- and postoperative care
• S3) Survey of referrals and interventions to general medical and geriatric medicine teams
Participant Duration:
• Follow-up on days one, three, and seven (if still in hospital)
• Telephone call follow-up four months after surgery
Proposed Inclusion Criteria (protocol pending):
People aged 60 or older undergoing any surgery during the recruitment period
• Elective surgery, emergency surgery, and planned day-case surgery
• General, neuraxial, and regional anaesthesia
• Those with the capacity to consent or have an appropriate consultee available to agree participation on their behalf (depending on version of study)
• Those who return to theatre during the data collection period
Proposed Exclusion Criteria (protocol pending):
• Cataract surgery
• Endoscopy performed without general anaesthesia
• Superficial surgery or minimally invasive procedures performed solely under topical / infiltration local anaesthesia (awake craniotomy for instance would be included)
• ASA VI
Frequently Asked Questions
Can I still join?
SNAP3 has finished data collection. We are not accepting further centres or data collectors. We thank our current collaborators and will be in touch with them in due course.
What is a SNAP project?
A SNAP project is a snapshot study, which aims to collect data from as many eligible patients as possible within a short data collection window.
What is SNAP 3 focusing on?
SNAP 3 is an observational study of frailty, delirium, and multimorbidity within the population of older patients undergoing surgery.
What does the study look like?
SNAP 3 is a UK-based study, so it will be necessary to adapt the protocol for use in ANZ. Broadly, it will likely be in three parts (ANZ protocol pending):
1. An organisational audit outlining hospital-level details (one per site)
2. A survey of activity by on-call medical/geriatric registrars to detail their ad hoc perioperative input into this patient population.
3. A patient study, comprising one of the following:
a. A study requiring patient consent, in-hospital patient-level data collection, and post-discharge telephone follow-up.
b. A trimmed down audit version without the need for patient consent nor post-discharge follow up (for those sites wishing to participate but unable to meet the full study protocol requirements).
When will SNAP 3 be running?
The UK arm of SNAP 3 is scheduled to collect data for 5 days in March 2022. The timing and duration of ANZ data collection has yet to be determined but is tentatively aiming to coincide with UK data collection, or shortly thereafter. here.
How can I get involved in the ANZ arm of SNAP 3?
Depending on your level of interest, there are a couple of ways you can help:
1. Become a site-lead to help run the project within your hospital.
2. Assist in patient recruitment and data collection within your hospital as a local investigator.
What is involved with being a site-lead?
Site-leads will be responsible for obtaining any site-specific approvals to run the project within their hospital and completing the study’s Organisational Audit. They will also need to establish a register of local investigators, and will oversee the local process for patient recruitment and data collection during the data collection window.
What is involved with being a local investigator?
Local investigators (under the coordination of the site-lead) will recruit patients to the study and complete all relevant case report forms.
What level of experience do I need to be involved as a site-lead?
For practical purposes, a named consultant should act as the site-lead. However, we are keen to support engagement from registrars and fellows and would encourage each site to also have a dedicated trainee lead, or for a trainee to act as co-lead under consultant supervision.
Can medical students take part?
Yes, medical students would be welcome to participate as local investigators.
Will I be paid for my time?
Unfortunately, no. Any involvement with SNAP 3 is on a voluntary basis.
Will my hospital be paid for participating?
There will be no per-patient payment. Depending on the outcome of grant applications, there may be a small token payment per site, but this is not guaranteed and should not be relied upon.
What is in it for me?
In previous SNAP projects, anyone registered as a local investigator or site-lead has be given evidence of their participation and named as a collaborator on any subsequent publications. It is anticipated that the same arrangement would apply to SNAP 3. Furthermore, the hope is that this project will help to develop relationships between the established and emerging trainee-led research collaboratives, both within and between speciality groups.
Is there a minimum number of patients that local sites are required to recruit?
Sites should aim to recruit all eligible patients during the data collection window, but there is no minimum number.
How can I get involved?
At the moment we are recruiting sites and Principal Investigators whilst the study goes through the HREC and ethics committees.
If you would like to register your hospital for SNAP 3 and haven’t yet got in touch then please contact us. We will keep you up to date with our progress!
If you are involved in the care of older surgical patients (eg an anaesthetist, surgeon, or geriatrician/general physician) and would like your hospital to participate in the study or audit, please get in touch via email and encourage your department to sign up