Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands.
Department of Gastroenterology, Amphia Hospital, Breda, The Netherlands.
BMC Geriatr. 2019 Mar 20;19(1):87. doi: 10.1186/s12877-019-1101-7.
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.
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.
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.
The protocol is retrospectively registered at the Netherlands National Trial Register (NTR) number: NTR5932 . Date of registration: 05-04-2016.
由于接受大型腹部手术的老年患者数量增加，术后并发症、住院时间延长、医疗保健费用和死亡率也随之增加。谵妄是“虚弱”老年患者的常见且严重的并发症。已经提出了不同的术前方法来通过改善患者的基础健康来降低谵妄的发生率。实施这些方法的研究往往具有异质性，样本量小，并且没有提供高质量或成功的策略。本研究的目的是通过实施独特的多组分和多学科的康复前计划来预防术后谵妄和其他并发症。
这是一项单中心对照前后研究。需要手术治疗结直肠癌或腹主动脉瘤的年龄≥70 岁的患者被认为符合条件。前瞻性收集基线特征（如虚弱因素、身体状况和营养状况）。在手术前 5 周内，患者将遵循康复前计划以优化整体健康状况，其中包括家庭锻炼、饮食建议和缺铁性贫血患者的静脉铁输注。如果存在虚弱，老年病医生将进行全面的老年评估，并在必要时提供额外的术前干预。主要结局是谵妄的发生率。次要结局是住院时间、并发症发生率、住院率、30 天、6 个月和 12 个月死亡率、心理健康和生活质量。结果将与符合相同纳入和排除标准、于 2013 年 1 月至 2015 年 10 月间接受手术的回顾性对照组进行比较。康复前队列的纳入始于 2015 年 11 月；数据收集正在进行中。
这是第一项研究康复前对术后谵妄影响的研究。目的是基于大样本量提供证据，以标准化的多组分策略来改善患者术前的身体和营养状况，从而预防术后谵妄和其他并发症。实施了一种多模式干预措施，结合了身体、营养、心理和血液优化。该研究涉及一个大的队列，包括最有可能发生术后不良结局的患者。
该方案在荷兰国家试验注册处（NTR）注册，编号为 NTR5932。注册日期：2016 年 4 月 5 日。
