Department of Surgery, Amphia Hospital, Breda, the Netherlands.
Department of Geriatrics, Amphia Hospital, Breda, the Netherlands.
Clin Interv Aging. 2022 May 11;17:767-776. doi: 10.2147/CIA.S357812. eCollection 2022.
Chronic limb threatening ischemia is the final stage of peripheral arterial disease. Current treatment is based on revascularization to preserve the leg. In the older, hospitalized chronic limb threatening ischemia patient, delirium is a frequent and severe complication after revascularization. Delirium leads to an increased length of hospital stay, a higher mortality rate and a decrease in quality of life. Currently, no specific guidelines to prevent delirium in chronic limb threatening ischemia patients exist. We aim to evaluate the effect of a multicomponent, multidisciplinary prehabilitation program on the incidence of delirium in chronic limb threatening ischemia patients ≥65 years.
A prospective observational cohort study to investigate the effects of the program on the incidence of delirium will be performed in a large teaching hospital in the Netherlands. This manuscript describes the design of the study and the content of this specific prehabilitation program.
Chronic limb threatening ischemia patients ≥65 years that require revascularization will participate in the program. This program focuses on optimizing the patient's overall health and includes delirium risk assessment, nutritional optimization, home-based physical therapy, iron infusion in case of anaemia and a comprehensive geriatric assessment in case of frailty. The primary outcome is the incidence of delirium. Secondary outcomes include quality of life, amputation-free survival, length of hospital stay and mortality. Exclusion criteria are the requirement of acute treatment or patients who are mentally incompetent to understand the procedures of the study or to complete questionnaires. A historical cohort from the same hospital is used as a control group.
This study will clarify the effect of a prehabilitation program on delirium incidence in chronic limb threatening ischemia patients. New insights will be obtained on optimizing a patient's preoperative mental and physical condition to prevent postoperative complications, including delirium.
This protocol is registered at the Netherlands National Trial Register (NTR) number: NL9380.
慢性肢体威胁性缺血是外周动脉疾病的终末阶段。目前的治疗方法基于血管重建以保留肢体。在年龄较大、住院的慢性肢体威胁性缺血患者中，谵妄是血管重建后常见且严重的并发症。谵妄导致住院时间延长、死亡率升高和生活质量下降。目前，尚无针对慢性肢体威胁性缺血患者预防谵妄的具体指南。我们旨在评估多组分、多学科预康复计划对≥65 岁慢性肢体威胁性缺血患者谵妄发生率的影响。
一项前瞻性观察队列研究，旨在研究该计划对谵妄发生率的影响，将在荷兰的一家大型教学医院进行。本文描述了该研究的设计和该特定预康复计划的内容。
需要血管重建的≥65 岁慢性肢体威胁性缺血患者将参加该计划。该计划侧重于优化患者的整体健康，包括谵妄风险评估、营养优化、家庭物理治疗、贫血患者铁输注以及虚弱患者全面老年评估。主要结局是谵妄发生率。次要结局包括生活质量、无截肢生存率、住院时间和死亡率。排除标准是需要急性治疗或患者因精神障碍而无法理解研究程序或完成问卷。来自同一医院的历史队列用作对照组。
本研究将阐明预康复计划对慢性肢体威胁性缺血患者谵妄发生率的影响。将获得优化患者术前身心状况以预防包括谵妄在内的术后并发症的新见解。
本方案在荷兰国家试验注册中心（NTR）注册，编号为 NL9380。
