Elder-friendly Approaches to the Surgical Environment-using Biological samples to Identify & provide Optimized care (EASE-BIO)

This study developed novel approaches to personalize patient care and match care to values by providing objective tools to physicians to empower and engage patients and caregivers with care planning and decision making, use state-of-the-art technology to create indicators to identify high-risk patients and use novel assessment tools to improve care across the continuum.

About the Project

Our research group has recently shown that using radiologic tools to assess severe muscle depletion (sarcopenia) is a strong predictor of older patients’ postoperative survival following emergency surgery. Sarcopenia has also been shown to be associated with loss of function, falls, fractures, increased need for rehabilitation and longer hospital stays in the elderly.

Evaluating patient-specific risk factors for postoperative complications in the emergency surgery setting is crucial for improving patient care and their outcomes. But to date, there has been no study evaluating the muscle biology in elderly following emergency surgery.

The objective of our research was to understand how muscle characteristic and patient’s biologic samples (blood, urine and stool) provide an insight to overall health outcomes. This knowledge not only identified high-risk patients, but also allowed for future personalized treatment (e.g. nutritional/diet modifications, targeted rehabilitation programs), preventative strategies and objective tools to help with patient decision making.

Project Team

Principal Investigator:

Rachel Khadaroo, MD, PhD, FRCSC — University of Alberta


Vickie Baracos, PhD — University of Alberta

David Broadhurst, BEng, MSc, PhD — University of Alberta

Vera Mazurak, PhD — University of Alberta

Gane Wong, PhD — University of Alberta

Knowledge Users and Partners:

Alberta Innovates

Department of Surgery, University of Alberta

Allyson Jones, PhD — University of Alberta

Duncan Robertson, MD — Alberta Health Services

Project Contact: Rachel Khadaroo — khadaroo@ualberta.ca

CAT 2014-31

Publications & Presentations


Salim, S.Y., Young, P.Y., Li, Y., Churchill, T.A., Khadaroo, R.G. (2016). Urine Intestinal Fatty Acid Binding Protein (I-FABP) Predicts Acute Mesenteric Ischemia in Patients. Journal of Surgical Research.

Wilson, R., Slaughter, S.E., Forbes, D., Hanson, H., Khadaroo, R.G. (2016). Experiences of a novice researcher conducting focus group interviews. International Journal of Nursing Student Scholarship, Vol. 3.

Leggett, L.E., Khadaroo, R.G., Holroyd-Leduc, J., Lorenzetti, D.L., Hanson, H., Wagg, A., Padwal, R., Clement, F. (March 2016) Measuring resource utilization: A systematic review of validated self-reported questionnaires. Medicine 95 (10): e2759.

Ali, T., Warkentin, L., Gazala, S., Wagg, A., Padwal, R., Khadaroo, R.G. (October 28, 2015).  Patient Reported Outcomes in Patients 65 years and older, admitted for Acute Care and Emergency Surgery: a Six Month Prospective Cohort StudyJournal of the American Geriatrics Society. E-pub. Doi: 10.1111/jgs.13783.

Lees, M., Merani, S., Tauh, K., Khadaroo, R.G. (October 2015) Perioperative Factors Predicting Poor Outcome in Elderly Patients Following Emergency General Surgery: A Multivariate Analysis. Canadian Journal of Surgery. 58(4) (E-released).

Khadaroo, R.G., Padwal, R.S., Wagg, A.S., Clement, F., Warkentin, L.M., Holroyd-Leduc, J. (August 21, 2015). Optimizing senior’s surgical care – Elder-friendly Approaches to the Surgical Environment (EASE) Study: rationale and objectives. BMC Health Services Research. Doi: 10.1186/s12913-015-1001-2.


AlMalki, N., Salim, S.Y., Emberg, M., Churchill, T.A., Khadaroo, R.G. (October 2015).  OSMR Deficiency Provides Protection in Sepsis-Induced Morbidity & Mortality in both Young and Adult Mice. American College of Surgeons.

Eamer, G.J., Clement, F., Churchill, T.A., Warkentin, L.M., Khadaroo, R.G. (October 2015). Post-Operative Costs to the Elderly Following Emergency Abdominal Surgery: A Canadian Prospective Multicentre Cost Analysis. College of Surgeons.

Alkathiri, O., Salim, S.Y., Warkentin, L., Churchill, T.A., Tandon, P., Khadaroo, R.G. (October 2015). Ultrasound Diagnosis of Sarcopenia is Predictive of Post-Operative Complications. American College of Surgeons.

AlMalki, N., Salim, S.Y., Churchill, T.A., Khadaroo, R.G. (April 2015). Deficiency in Oncostatin M Receptor Results in Improved Survival in Older Mice Following Sepsis Through Down-Regulation of IL-10. Surgical Infections, 16 (S1), S-10.

Salim, S.Y., AlMalki, N., Khadaroo, R.G., Churchill, T. (April 2015). Oncostatin M Receptor Deficiency Results in Attenuated Peritoneal Inflammatory response enhanced survival in a murine sepsis model. Surgical Infections, 16 (S1), S-26.

Salim, S.Y., AlMalki, N., Churchill, T.A., Khadaroo, R.G. (February 2015). Oncostatin M Receptor Deficiency Protects Against Sepsis in Older Mice.  Academic Surgical Congress, #61.16, 72.

Warkentin, L.M., Ali, T.F., Gazala, S., Wagg, A., Padwall, R., Khadaroo, R.G. (February 2015).  Change in Functional Status and Quality of Life in Elders Admitted to an Acute Care Surgery Service.  Academic Surgical Congress, #64.19 75.

Rationale, Hypothesis, Objectives & Research Plan

Rationale: Our research group has recently shown that using radiologic tools to assess severe muscle depletion (sarcopenia) is a strong predictor of older patients’ postoperative survival following emergency surgery. To date, there has been no study evaluating the muscle biology in frail elderly following emergency surgery.

Hypothesis: Muscle characterization and metabolomics, coupled with microbiota profiling can offer novel biomarker-based tools to identify frail elderly patients who are at risk for poor health outcomes.

Objectives: (1) Characterize the muscle, metabolomics, and microbiota profiles of frail surgical patients, (2) demonstrate that these profiles can identify elderly frail patients who are at high-risk for poor health outcomes following surgery and (3) Examine how applying Elder-friendly Approaches to the Surgical Environment (EASE) Study interventions alters patient’s biological profile and improves surgical outcomes.

Note: This grant is a sub-study of a larger EASE prospective study funded by Alberta Innovates Health Solutions (AIHS). The EASE interventions include interdisciplinary team based care and elder-friendly evidenced informed care practices.

Research plan: The CFN study is examining patient muscle biology, metabolomics, and gut microbiota profiles. Biological samples are being collected longitudinally at admission (blood, urine, stool), intra-operatively (muscle) and on the fifth postoperative day (blood, urine and stool) and non-invasive samples are being collected at six weeks following surgery. There will be 6 months of biologic data collection prior to and after the EASE intervention. The biological samples will be analyzed and correlated with clinical outcomes.