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Multimodal prehabilitation to reduce the incidence of delirium and other adverse events in elderly patients undergoing elective major abdominal surgery: An uncontrolled before-and-after study.

Abstract

BACKGROUND

Delirium is a common and serious complication in elderly patients undergoing major abdominal surgery, with significant adverse outcomes. Successful strategies or therapies to reduce the incidence of delirium are scarce. The objective of this study was to assess the role of prehabilitation in reducing the incidence of delirium in elderly patients.

METHODS

A single-center uncontrolled before-and-after study was conducted, including patients aged 70 years or older who underwent elective abdominal surgery for colorectal carcinoma or an abdominal aortic aneurysm between January 2013 and October 2015 (control group) and between November 2015 and June 2018 (prehabilitation group). The prehabilitation group received interventions to improve patients' physical health, nutritional status, factors of frailty and preoperative anaemia prior to surgery. The primary outcome was incidence of delirium, diagnosed with the DSM-V criteria or the confusion assessment method. Secondary outcomes were additional complications, length of stay, unplanned ICU admission, length of ICU stay, readmission rate, institutionalization, and in-hospital or 30-day mortality.

RESULT

A total of 360 control patients and 267 prehabilitation patients were included in the final analysis. The mean number of prehabilitation days was 39 days. The prehabilitation group had a higher burden of comorbidities and was more physically and visually impaired at baseline. At adjusted logistic regression analysis, delirium incidence was reduced significantly from 11.7 to 8.2% (OR 0.56; 95% CI 0.32-0.98; P = 0.043). No statistically significant effects were seen on secondary outcomes.

CONCLUSION

Current prehabilitation program is feasible and safe, and can reduce delirium incidence in elderly patients undergoing elective major abdominal surgery. This program merits further evaluation.

TRIAL REGISTRATION

Dutch Trial Registration, NTR5932.

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  • Authors+Show Affiliations

    ,

    Department of Surgery, Amphia Hospital, Breda, the Netherlands.

    ,

    Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.

    ,

    Department of Surgery, Amphia Hospital, Breda, the Netherlands.

    ,

    Department of Surgery, Amphia Hospital, Breda, the Netherlands.

    ,

    Department of Surgery, Amphia Hospital, Breda, the Netherlands.

    ,

    Department of Gastroenterology, Amphia Hospital, Breda, the Netherlands.

    ,

    Department of Geriatrics, Amphia Hospital, Breda, the Netherlands.

    ,

    Department of Surgery, Amphia Hospital, Breda, the Netherlands.

    ,

    Department of Surgery, Amphia Hospital, Breda, the Netherlands.

    ,

    Department of Surgery, Amphia Hospital, Breda, the Netherlands.

    ,

    Department of Physical Therapy, Amphia Hospital, Breda, the Netherlands.

    Department of Surgery, Amphia Hospital, Breda, the Netherlands.

    Source

    PloS one 14:6 2019 pg e0218152

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31194798

    Citation

    Janssen, T L., et al. "Multimodal Prehabilitation to Reduce the Incidence of Delirium and Other Adverse Events in Elderly Patients Undergoing Elective Major Abdominal Surgery: an Uncontrolled Before-and-after Study." PloS One, vol. 14, no. 6, 2019, pp. e0218152.
    Janssen TL, Steyerberg EW, Langenberg JCM, et al. Multimodal prehabilitation to reduce the incidence of delirium and other adverse events in elderly patients undergoing elective major abdominal surgery: An uncontrolled before-and-after study. PLoS ONE. 2019;14(6):e0218152.
    Janssen, T. L., Steyerberg, E. W., Langenberg, J. C. M., de Lepper, C. C. H. A. V. H., Wielders, D., Seerden, T. C. J., ... van der Laan, L. (2019). Multimodal prehabilitation to reduce the incidence of delirium and other adverse events in elderly patients undergoing elective major abdominal surgery: An uncontrolled before-and-after study. PloS One, 14(6), pp. e0218152. doi:10.1371/journal.pone.0218152.
    Janssen TL, et al. Multimodal Prehabilitation to Reduce the Incidence of Delirium and Other Adverse Events in Elderly Patients Undergoing Elective Major Abdominal Surgery: an Uncontrolled Before-and-after Study. PLoS ONE. 2019;14(6):e0218152. PubMed PMID: 31194798.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Multimodal prehabilitation to reduce the incidence of delirium and other adverse events in elderly patients undergoing elective major abdominal surgery: An uncontrolled before-and-after study. AU - Janssen,T L, AU - Steyerberg,E W, AU - Langenberg,J C M, AU - de Lepper,C C H A van Hoof-, AU - Wielders,D, AU - Seerden,T C J, AU - de Lange,D C, AU - Wijsman,J H, AU - Ho,G H, AU - Gobardhan,P D, AU - van Alphen,R, AU - van der Laan,L, Y1 - 2019/06/13/ PY - 2019/03/07/received PY - 2019/05/27/accepted PY - 2019/6/14/entrez PY - 2019/6/14/pubmed PY - 2019/6/14/medline SP - e0218152 EP - e0218152 JF - PloS one JO - PLoS ONE VL - 14 IS - 6 N2 - BACKGROUND: Delirium is a common and serious complication in elderly patients undergoing major abdominal surgery, with significant adverse outcomes. Successful strategies or therapies to reduce the incidence of delirium are scarce. The objective of this study was to assess the role of prehabilitation in reducing the incidence of delirium in elderly patients. METHODS: A single-center uncontrolled before-and-after study was conducted, including patients aged 70 years or older who underwent elective abdominal surgery for colorectal carcinoma or an abdominal aortic aneurysm between January 2013 and October 2015 (control group) and between November 2015 and June 2018 (prehabilitation group). The prehabilitation group received interventions to improve patients' physical health, nutritional status, factors of frailty and preoperative anaemia prior to surgery. The primary outcome was incidence of delirium, diagnosed with the DSM-V criteria or the confusion assessment method. Secondary outcomes were additional complications, length of stay, unplanned ICU admission, length of ICU stay, readmission rate, institutionalization, and in-hospital or 30-day mortality. RESULT: A total of 360 control patients and 267 prehabilitation patients were included in the final analysis. The mean number of prehabilitation days was 39 days. The prehabilitation group had a higher burden of comorbidities and was more physically and visually impaired at baseline. At adjusted logistic regression analysis, delirium incidence was reduced significantly from 11.7 to 8.2% (OR 0.56; 95% CI 0.32-0.98; P = 0.043). No statistically significant effects were seen on secondary outcomes. CONCLUSION: Current prehabilitation program is feasible and safe, and can reduce delirium incidence in elderly patients undergoing elective major abdominal surgery. This program merits further evaluation. TRIAL REGISTRATION: Dutch Trial Registration, NTR5932. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/31194798/Multimodal_prehabilitation_to_reduce_the_incidence_of_delirium_and_other_adverse_events_in_elderly_patients_undergoing_elective_major_abdominal_surgery:_An_uncontrolled_before-and-after_study L2 - http://dx.plos.org/10.1371/journal.pone.0218152 DB - PRIME DP - Unbound Medicine ER -