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 .

Intravenous Iron in a Prehabilitation Program for Older Surgical Patients: Prospective Cohort Study

“…The hematinic component of the prehabilitation program may not have contributed to the decreased incidence of delirium 10 because results of the present study do not present a difference in this outcome between both groups. However, based on the previous literature, a higher incidence of delirium could be expected in anemic patients compared with nonanemic patients.…”

“…[6][7][8] Both CRC and AAA require abdominal surgery as definitive treatment and have been used together in studies on delirium after major abdominal surgery. [10][11][12] Delirium is the most frequent surgical complication and a common outcome after surgery for both CRC and AAA in older patients.…”

“…29 IVIS has recently been used in our prehabilitation program to prevent postoperative delirium and other adverse events in older patients after major abdominal surgery for CRC and AAA. 10 This program was able to reduce the incidence of postoperative delirium, but did not affect the number of complications, readmissions, or short-term mortality and did not differentiate between patients with IDA and patients with other types of anemia (OA). The aim of this research was to assess the effectiveness and safety of using IVIS in a prehabilitation program by assessing the changes in Hb and iron parameter measures in anemic patients who received IVIS.…”

The role of physical exercise and rehabilitation in delirium

“…Usual prehabilitation programs that include physical and nutritional interventions have demonstrated to reduce the incidence of post-operative complications, shorten hospital stay and improve healthrelated quality of life [118,119], also in frail patients [120]. Regarding delirium, we are beginning to observe positive effects of prehabilitation programs with a reduction in delirium incidence [121], although more studies are needed.…”

Prehabilitation in elderly patients scheduled for liver resection and protocol for Recovery Of Surgery in Elderly

“…Most trials report clinical outcomes through careful patient selection and elimination of emergent cases and those in need of urgent intervention. Janssen et al [23] has reported single centre uncontrolled before and after study including 627 patients aged 70 years and older and undergoing elective abdominal surgery for colorectal carcinoma or aortic aneurysm. The prehabilitation group received interventions to improve patients' physical health, nutritional status, frailty and anaemia prior to surgery.…”