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A multicomponent prehabilitation pathway to reduce the incidence of delirium in elderly patients in need of major abdominal surgery: study protocol for a before-and-after study.
BMC Geriatr 2019; 19(1):87BG

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.

Authors+Show Affiliations

Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands. tjanssen@amphia.nl.Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands.Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands.Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands.Department of Gastroenterology, Amphia Hospital, Breda, The Netherlands.Department of Public Health, Erasmus MC-University Medical center Rotterdam, Rotterdam, The Netherlands.Department of Clinical Chemistry and Hematology, Amphia Hospital, Breda, The Netherlands.Department of Geriatrics, Amphia Hospital, Breda, The Netherlands.Department of Physical Therapy, Amphia Hospital, Breda, The Netherlands.Department of Dieticians, Amphia Hospital, Breda, The Netherlands.Medical Manager Surgery, Amphia Hospital, Breda, The Netherlands.Department of Medical Psychology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands. Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands.Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands.Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands.Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30894131

Citation

Janssen, Ties L., et al. "A Multicomponent Prehabilitation Pathway to Reduce the Incidence of Delirium in Elderly Patients in Need of Major Abdominal Surgery: Study Protocol for a Before-and-after Study." BMC Geriatrics, vol. 19, no. 1, 2019, p. 87.
Janssen TL, Mosk CA, van Hoof-de Lepper CCHA, et al. A multicomponent prehabilitation pathway to reduce the incidence of delirium in elderly patients in need of major abdominal surgery: study protocol for a before-and-after study. BMC Geriatr. 2019;19(1):87.
Janssen, T. L., Mosk, C. A., van Hoof-de Lepper, C. C. H. A., Wielders, D., Seerden, T. C. J., Steyerberg, E. W., ... van der Laan, L. (2019). A multicomponent prehabilitation pathway to reduce the incidence of delirium in elderly patients in need of major abdominal surgery: study protocol for a before-and-after study. BMC Geriatrics, 19(1), p. 87. doi:10.1186/s12877-019-1101-7.
Janssen TL, et al. A Multicomponent Prehabilitation Pathway to Reduce the Incidence of Delirium in Elderly Patients in Need of Major Abdominal Surgery: Study Protocol for a Before-and-after Study. BMC Geriatr. 2019 Mar 20;19(1):87. PubMed PMID: 30894131.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A multicomponent prehabilitation pathway to reduce the incidence of delirium in elderly patients in need of major abdominal surgery: study protocol for a before-and-after study. AU - Janssen,Ties L, AU - Mosk,Christina A, AU - van Hoof-de Lepper,Chantal C H A, AU - Wielders,Daphne, AU - Seerden,Tom C J, AU - Steyerberg,Ewout W, AU - van Gammeren,Adriaan J, AU - de Lange,Dominique C, AU - van Alphen,René, AU - van der Zee,Martine, AU - de Bruijn,René M, AU - de Vries,Jolanda, AU - Wijsman,Jan H, AU - Ho,Gwan H, AU - Gobardhan,Paul D, AU - van der Laan,Lijckle, Y1 - 2019/03/20/ PY - 2018/06/20/received PY - 2019/03/06/accepted PY - 2019/3/22/entrez PY - 2019/3/22/pubmed PY - 2019/3/22/medline KW - Abdominal aortic aneurysm KW - Colorectal surgery KW - Delirium KW - Geriatric patient KW - Multicomponent KW - Prehabilitation KW - Prevention KW - Quality of life SP - 87 EP - 87 JF - BMC geriatrics JO - BMC Geriatr VL - 19 IS - 1 N2 - 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. SN - 1471-2318 UR - https://www.unboundmedicine.com/medline/citation/30894131/A_multicomponent_prehabilitation_pathway_to_reduce_the_incidence_of_delirium_in_elderly_patients_in_need_of_major_abdominal_surgery:_study_protocol_for_a_before_and_after_study_ L2 - https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1101-7 DB - PRIME DP - Unbound Medicine ER -