Improvement of perioperative care of the elderly patient (PeriAge): protocol of a controlled interventional feasibility study

Abstract

IntroductionGeriatric patients have a pronounced risk to suffer from postoperative complications. While effective risk-specific perioperative measures have been studied in controlled experimental settings, they are rarely found in routine healthcare. This study aims (1) to implement a multicomponent preoperative and intraoperative intervention, and investigate its feasibility, and (2) exploratorily assess the effectiveness of the intervention in routine healthcare.Methods and analysisFeasibility and exploratory effectiveness of the intervention will be investigated in a monocentric, prospective, non-randomised, controlled trial. The intervention includes systematic information for patients and family about measures to prevent postoperative complications; preoperative screening for frailty, malnutrition, strength and mobility with nutrient supplementation and physical exercise (prehabilitation) as needed. Further components focus on potentially inadequate medication, patient blood-management and carbohydrate loading prior to surgery, retainment of orientation aids in the operating room and a geriatric anaesthesia concept. Data will successively be collected from control, implementation and intervention groups. Patients aged 65+ with impending surgery will be included. A sample size of 240, n=80 per group, is planned. Assessments will take place at inclusion and 2, 30 and 180 days after surgery. Mixed-methods analyses will be performed. Exploratory effectiveness will be assessed using mixed segmented regressions. The primary endpoint is functional status. Secondary endpoints include cognitive performance, health-related quality of life, length of inpatient stay and occurrence of postoperative complications. Feasibility will be assessed through semi-structured interviews with staff and patients and quantitative analyses of the data quality, focussing on practicability, acceptance, adoption and fidelity to protocol.Ethics and disseminationThe study will be carried out in accordance with the Helsinki Declaration and to principles of good scientific practice. The Ethics Committee of the Medical Association Hamburg, Germany, approved the protocol (study ID: PV5596). Results will be disseminated in scientific journals and healthcare conferences.Trial registration numberClinicalTrials.gov Identifier: NCT03325413.

Does Preoperative Cognitive Optimization Improve Postoperative Outcomes in the Elderly?

“…In addition, there are clinical trials being conducted to evaluate a multidisciplinary, multicomponent perioperative intervention that does not include a specific cognitive training program [79,80]. The Perioperative Enhancement of Cognitive Trajectory (PROTECT) trial is a randomized, controlled, multicenter, single-blind clinical trial that investigates a multidisciplinary perioperative intervention.…”

“…This study will provide valuable information on how general preoperative optimization without cognitive training improves cognitive trajectory. The feasibility of a multicomponent preoperative and intraoperative intervention including comprehensive preoperative counselling and sensory orientation aids is also being investigated for a variety of surgeries, with the minimum exclusion of neurocerebral and ophthalmological surgeries [80].…”

Cuidados perioperatorios en el paciente adulto mayor

“…Los cambios en la fisiología debido al envejecimiento y una mayor prevalencia de condiciones comórbidas colocan en una posición de mayor riesgo de complicaciones perioperatorias al adulto mayor (6,8,9), tales como delirio postoperatorio, infección pulmonar, eventos cardiovasculares y una tasa general más alta de morbilidad postoperatoria, hospitalizaciones prolongadas y mortalidad, además de deterioro general y cognitivo a largo plazo (8,10,11). Si bien los pacientes ancianos que se someten a cirugía tienen mayores riesgos de morbimortalidad, la edad cronológica por sí sola puede ser un mal predictor.…”

“…Los pacientes de edad avanzada tienen un mayor riesgo de complicaciones posoperatorias como delirio, caídas, mala nutrición, infecciones del tracto urinario y otras infecciones iatrogénicas, úlceras por presión y deterioro funcional (6). Los factores de riesgo más comúnmente asociados con estas complicaciones son un estado funcional reducido, discapacidad, mala condición física y movilidad, desnutrición, polifarmacia y morbilidad (8). Si bien se han estudiado medidas perioperatorias específicas eficaces en entornos experimentales controlados, rara vez se encuentran en la asistencia sanitaria de rutina (8).…”

“…Los factores de riesgo más comúnmente asociados con estas complicaciones son un estado funcional reducido, discapacidad, mala condición física y movilidad, desnutrición, polifarmacia y morbilidad (8). Si bien se han estudiado medidas perioperatorias específicas eficaces en entornos experimentales controlados, rara vez se encuentran en la asistencia sanitaria de rutina (8). El Colegio Americano de Cirujanos ha reconocido la necesidad de evaluar procesos de atención que puedan ayudar a optimizar los resultados de los pacientes ancianos sometidos a cirugía (3).…”