Frailty and Outcomes Following Hip Surgery

Frailty is a geriatric syndrome which affects up to one in eight adults aged 70-79 years rising to around one third of those aged 80-89 years. It has been defined as a state associated with impaired physiological reserve and a reduced ability to regain homeostasis following a destabilising event. Hip joint surgery undertaken to repair fractures and also to replace end stage osteoarthritic joints is one of the most frequent procedures performed in older people, however, the impact of frailty on health outcomes following hip surgery is not well known. Such data are important and may help inform shared decisions about surgery or type of surgery in this vulnerable group. The broad aim of the project is to determine the influence of frailty on outcomes following hip joint surgery in older people. Specific objectives include assessment of the impact of frailty on short and long term outcomes including mortality, the occurrence of falls, fractures, analgesic use, and social care. The student will look also at whether frailty is associated with an increased risk of adverse effects related to analgesic use.

The study will utilise data from the Salford Integrated Record (SIR) System, a unique resource linking primary and secondary care records and permitting for the purpose of this project acquisition of detailed information about the underlying disease process, type of joint surgery, and rich information about short (hospital based) and longer term outcomes. Information about frailty is collected as part of a patient’s admission (Clinical Frail Score) and also there is information about frailty based on GP records (electronic Frailty Index). The student will also exploit the SIR to develop a novel laboratory-based frailty index based on routine laboratory tests performed and validate this against existing measures. The student will undertake exploratory work investigating elements of frailty, and how they relate to the new index, and existing indices, to best describe how it and existing elements work. Using multiple regression analysis the student will utilise linked information available in SIR to determine how the different frailty measures predict short and long term outcomes following joint surgery. The definition of the frailty index, and the type of short- and long-term outcomes will shape the precise type of regression analysis used (logistic, ordinal, Cox proportional hazards), and will be determined by the student through their exploration of the literature – part of the project requires understanding what short- and long-term outcomes are most relevant and important to clinicians and patients. The proposed start date is September 2020. The proposed research will help better define the risks and potential benefits of hip surgery in older people.

Entry Requirements
Applicants are expected to hold, or about to obtain, a minimum upper second class undergraduate degree (or equivalent) in a biomedical discipline. A Masters degree in a relevant subject and/or experience in biomedical research is desirable.

For information on how to apply for this project, please visit the Faculty of Biology, Medicine and Health Doctoral Academy website (https://www.bmh.manchester.ac.uk/study/research/apply/). Informal enquiries may be made directly to the primary supervisor. You MUST also submit an online application form - choose PhD Musculoskeletal.