A multicomponent prehabilitation pathway to reduce the incidence of delirium in elderly patients in need of major abdominal surgery: study ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2019-12

AUTHORS

Ties L. Janssen, Christina A. Mosk, Chantal C. H. A. van Hoof-de Lepper, Daphne Wielders, Tom C. J. Seerden, Ewout W. Steyerberg, Adriaan J. van Gammeren, Dominique C. de Lange, René van Alphen, Martine van der Zee, René M. de Bruijn, Jolanda de Vries, Jan H. Wijsman, Gwan H. Ho, Paul D. Gobardhan, Lijckle van der Laan

ABSTRACT

BACKGROUND: Due to the increase in elderly patients who undergo major abdominal surgery there is a subsequent increase in postoperative complications, prolonged hospital stays, health-care costs and mortality rates. Delirium is a frequent and severe complication in the 'frail' elderly patient. Different preoperative approaches have been suggested to decrease incidence of delirium by improving patients' baseline health. Studies implementing these approaches are often heterogeneous, have a small sample and do not provide high-quality or successful strategies. The aim of this study is to prevent postoperative delirium and other complications by implementing a unique multicomponent and multidisciplinary prehabilitation program. METHODS: This is a single-center controlled before-and-after study. Patients aged ≥70 years in need of surgery for colorectal cancer or an abdominal aortic aneurysm are considered eligible. Baseline characteristics (such as factors of frailty, physical condition and nutritional state) are collected prospectively. During 5 weeks prior to surgery, patients will follow a prehabilitation program to optimize overall health, which includes home-based exercises, dietary advice and intravenous iron infusion in case of anaemia. In case of frailty, a geriatrician will perform a comprehensive geriatric assessment and provide additional preoperative interventions when deemed necessary. The primary outcome is incidence of delirium. Secondary outcomes are length of hospital stay, complication rate, institutionalization, 30-day, 6- and 12-month mortality, mental health and quality of life. Results will be compared to a retrospective control group, meeting the same inclusion and exclusion criteria, operated on between January 2013 and October 2015. Inclusion of the prehabilitation cohort started in November 2015; data collection is ongoing. DISCUSSION: This is the first study to investigate the effect of prehabilitation on postoperative delirium. The aim is to provide evidence, based on a large sample size, for a standardized multicomponent strategy to improve patients' preoperative physical and nutritional status in order to prevent postoperative delirium and other complications. A multimodal intervention was implemented, combining physical, nutritional, mental and hematinic optimization. This research involves a large cohort, including patients most at risk for postoperative adverse outcomes. TRIAL REGISTRATION: The protocol is retrospectively registered at the Netherlands National Trial Register (NTR) number: NTR5932 . Date of registration: 05-04-2016. More... »

PAGES

87

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12877-019-1101-7

DOI

http://dx.doi.org/10.1186/s12877-019-1101-7

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1112898528

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30894131


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406 Department of Geriatrics, Amphia Hospital, Breda, The Netherlands
407 Department of Physical Therapy, Amphia Hospital, Breda, The Netherlands
408 Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands
409 Medical Manager Surgery, Amphia Hospital, Breda, The Netherlands
410 rdf:type schema:Organization
411 https://www.grid.ac/institutes/grid.5645.2 schema:alternateName Erasmus University Medical Center
412 schema:name Department of Public Health, Erasmus MC-University Medical center Rotterdam, Rotterdam, The Netherlands
413 rdf:type schema:Organization
 




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