The focus of this study is the development of a perioperative treatment concept for elderly patients, based on individual necessities and risk factors, aiming to improve patient outcome. The planned interventions include preoperative screening for malnutrition, frailty and uncalled-for long-term medication, if required followed by early prophylaxis and treatment of these risk factors, prior to or during surgery.
In Germany every second inpatient surgical intervention is performed on patients aged 60 years and above. These patients often offer an extensive set of risk factors such as frailty, malnutrition, poor physical fitness and multi-morbidity that may in turn lead to longer hospitalizations and decline of health and functional status after surgery. An age-related increase in postoperative complications, such as postoperative cognitive dysfunction (POCD) and delirium is associated with a higher rate of postoperative morbidity, mortality and longer hospitalization. Early detection of risk factors and implementation of prophylactic measures is important to reduce postoperative complications and improve clinical outcomes in elderly patients. The aim of our study is to develop and verify a protocol - which allows for a systematic evaluation of risk factors and the implementation of prophylactic or therapeutic measures in order to optimize the postoperative outcome. The feasibility of our protocol will be verified in clinical practice by systematic process evaluations.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
310
Systematic inclusion of family members/ reference person in the perioperative process
Detailed preoperative information about delirium prevention and procedures
Preoperative execution of physical and breathing exercises if necessary
Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf (UKE)
Hamburg, Germany
Functional abilities
Change in functional abilities from baseline, evaluated by Instrumental Activities of Daily Living (IADL) score
Time frame: Evaluation preoperatively, 1 month, 6 months after surgery
Cognitive impairment
DemTect: cognitive screening instrument, sensitive to the early symptoms of dementia
Time frame: Evaluation preoperatively, at 2-5 days, 1 month, 6 months after surgery
Attention and task switching
The Trail Making Test A\&B (TMT A\&B): a neuropsychological test of visual attention and task alternation
Time frame: Evaluation preoperatively, at 2-5 days, 1 month, 6 months after surgery
Attentional capabilities
TAP Alertness: a computerized, standardized neuropsychological test for attentional performance.
Time frame: Evaluation preoperatively, at 2-5 days, 1 month, 6 months after surgery
Health related quality of life
Measured by a 12-item short-form (SF-12) Health Survey
Time frame: Evaluation preoperatively, 1 month, 6 months after surgery
Hospital length of stay
Day of admission until day of discharge
Time frame: 1 month
Postoperative complications
Incidence of postoperative complications
Time frame: Evaluation evaluation of complications at 2-5 days, 1 month, 6 months after surgery
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Dietary supplements if necessary
Avoidance of unsuitable drugs for elderly if possible
Regional anesthesia whenever possible
Personal orientation aids until anesthesia induction
Perioperative warming
Using Bispectral index (BIS) to measure the depth of anesthesia
A pain catheter will be used as postoperative pain therapy if possible