The project "QV-POD-2" is a prolongation based on "QV-POD-1", which was a quality contract program of the IQTIG - Institute for Quality and Transparency in Health Care. The aim is to improve inpatient care for older patients who are undergoing inpatient surgery and thus to specifically reduce the postoperative risk of delirium. This is achieved through the implementation of evidence-based and consensus-based measures to prevent postoperative delirium in a comprehensive structured concept in routine care. The transparent documentation in an electronic patient file enables the relationships between the symptoms to be depicted in accordance with the clinical circumstances and the genesis of the postoperative delirium to be recorded and treated at an early stage. The content of the additional elements from the routine data (see primary and secondary outcome measures) in QV-POD-2 is analysed internally. Subproject Retro-Pressure started in August 2022: Retrospective, exploratory cohort study using electronic anesthesia and hospital records from Jan 1, 2016 to Jan 1, 2020, including patients ≥70 years undergoing surgery with anesthesia. The objective is to quantify associations between intraoperative blood pressure dynamics-variability, rate of change, relative hypo-/hypertension versus baseline, and time-integrated BP (area under/above reference)-and postoperative organ dysfunction Primary endpoints: Emergence delirium incidence (PACU/ITS) based on Nu-DESC scores and CAM-ICU scores; incidence of postoperative acute renal failure (creatinine and urea levels, as well as urine output); intraoperative blood pressure variation\*; intraoperative blood pressure variation rate\*; intraoperative blood pressure integral\* Secondary endpoints: Blood count (hemoglobin and hematocrit values); intraoperative transfusions of blood reserves Addendum from the ethics amendment vote of 25/07/2022 Subproject Delta-Scan started in August 2022: Evaluation of brain function using "Delta Scan" Primary objective: Evaluation of the prognostic significance of Delta Scan measurements in relation to postoperative delirium Secondary objectives: Examination of the delirium-related predictive relevance of individual influencing factors (directly but also indirectly through Delta Scan values) and examination of the effect of Delta Scan measurements on standard delirium screening methods. Study and control group's Inclusion criteria: Age \>= 70 years and major surgery with anesthesia; additional exclusion criterion in the control group: Inclusion in the QV-POD-1 project (receipt of postoperative preventive measures) Addendum from the ethics amendment vote of 25/07/2022
The quality contract of the Charité Universitätsmedizin Berlin QV-POD was contractually extended so that the patients of the Charité Universitätsmedizin Berlin can be offered the preventive measures for delirium for another 5 years (07/01/2023 - 06/30/2028). The continuation of the contract is referred to with the short title QV-POD-2. In terms of content, all preventive measures known from QV-POD will be continued.
Study Type
OBSERVATIONAL
Enrollment
18,100
Department of Anesthesiology and Intensive Care Medicine (CBF), Charité - Universitätsmedizin Berlin
Berlin, Germany
RECRUITINGDepartment of Anesthesiology and Intensive Care Medicine (CCM/CVK) Berlin, Carité - Universitätsmedizin Berlin
Berlin, Germany
RECRUITINGSustainability of implementation rates
QV-POD-2: Sustainability of implementation rates (=Number of patients who underwent delirium screening at least twice a day within the first three days postoperatively / Divisor = All recruited patients) of at least 80% for screening and documentation in the next five years.
Time frame: Up to 5 years
Implementation rates
QV-POD-1: Implementation rates (=Number of patients who underwent delirium screening at least twice a day within the first three days postoperatively / Divisor = All recruited patients) of at least 60% for screening and documentation in the first year, at least 70% in the second year and at least 80% in the third year. Addendum to the primary outcome measures from the ethics amendment vote of 25/07/2022)
Time frame: Up to 3 years
Sustainability of implementation rates
QV-POD-2: Sustainability of implementation rates (=Number of patients who underwent delirium screening at least twice a day within the first five days postoperatively / Divisor = All recruited patients) of at least 80% for screening and documentation in the next five years
Time frame: Up to 5 years
Implementation rates
QV-POD-1: Implementation rates (=Number of patients who underwent delirium screening at least twice a day within the first five days postoperatively / Divisor = All recruited patients) of at least 60% for screening and documentation in the first year, at least 70% in the second year and at least 80% in the third year. Addendum to the secondary outcome measures from the ethics amendment vote of 25/07/2022)
Time frame: Up to 5 years
Care level
The care level is taken from hospital records preoperatively and postoperatively
Time frame: Up to one year
Routine laboratory
Routine laboratory markers
Time frame: The participants are followed up until the end of hospital stay, an expected average of 7 days
Routine vital parameters
Time frame: The participants are followed up until the end of hospital stay, an expected average of 7 days
Measurement of cholinesterases
Cholinesterases (point of care testing (POCT) measurements) are measured in the routine
Time frame: The participants are followed up until the end of hospital stay, an expected average of 7 days
Intraoperative routine data
Time frame: Time of surgery
Postoperative routine data on the ICU, in the recovery room and normal ward
Time frame: The participants are followed up until the end of hospital stay, an expected average of 7 days
Drug administration during inpatient treatment
Time frame: The participants are followed up until the end of hospital stay, an expected average of 7 days
Routine preventive measures against delirium
Time frame: The participants are followed up until the end of hospital stay, an expected average of 7 days
Intraoperative documented peculiarities in patients with delirium
Time frame: Time of surgery
Anticholinergic drug intake
Scale to identify the severity of anticholinergic drugs (Level 0 = no anticholinergic effect, Level 1 = mild anticholinergic effect, Level 2 = moderate anticholinergic effect, Level 3 = severe anticholinergic effect). The sum of all levels of the different drugs gives the total load. Higher total loads of anticholinergic drugs are associated with higher anticholinergic drug load. Minimum of the scale is 0. Maximum depends on the sum of each drug level. The more drugs with anticholinergic effect are taken the higher is the anticholinergic drug load.
Time frame: The participants are followed up until the end of hospital stay, an expected average of 7 days
Duration of postoperative delirium
Duration of postoperative delirium in all postoperative patients in normal ward, intensive care unit and recovery room is measured in days (a defined day before the start of the training measures, a defined day after the completion of the training measures). Addendum to the secondary outcome measures from the ethics amendment vote of 25/07/2022)
Time frame: The participants are followed up until the end of hospital stay, an expected average of 7 days
Incidence of postoperative delirium
Incidence of postoperative delirium in all postoperative patients in normal ward, intensive care unit and recovery room after validated delirium screening tool at two points in time (a defined day before the start of the training measures, a defined day after the completion of the training measures).
Time frame: The participants are followed up until the end of hospital stay, an expected average of 7 days
Electroencephalography (EEG) measurement
Objective non-invasive EEG is measured intraoperatively
Time frame: During the duration of surgery, an expected average of 2 hours
Infections
Infections according to surgical site infections (SSI) and according to the US Centers for Disease Control and Preventions (CDC).
Time frame: The participants are followed up until the end of hospital stay, an expected average of 7 days
Quality of life 1
Health related quality of life is measured by EQ-5D-5L
Time frame: Up to three months
Post Intensive Care Syndrome (PICS)
The composite outcome measure "PICS" of the patient is measured according to Needham et al 2012: new impairment or worsening of health after intensive care unit stay and at the same time clinically significant distress in at least one of the following outcome measurement instruments: Patient Health Questionnaires (PHQ-9, PHQ-8, PHQ-4), Generalized Anxiety Disorder Scales (GAD-2 and GAD-7), Impact of Event Scale Revised (IES-R), MiniCog, Animal Naming Test, Trail Making Test (TMT-A, TMT-B), Repeatable Battery for the Assessment of Neuropsychological Satus (RBANS), Timed Up-and-Go (TUG), Handgrip Strength, EQ-5D-5L, subjective assessment NRS, WHO Disability Assessment Schedule (WHODAS), Short Physical Performance Battery (SPPB). The Measurement will be performed, when patients present to the outpatient clinic for follow-up examinations. Optionally, the measurement can also be performed via outpatient structures or during a home visit.
Time frame: Up to one year
Postoperative complications
To evaluate the presence or development of postoperative organ complications during inpatient care
Time frame: The participants are followed up until the end of hospital stay, an expected average of 7 days
Analgesia consumption
Concomitant pain medication is recorded
Time frame: Up to one year
Postoperative cognitive impairment
Telephone or Video or questionnaire Follow up is offered to every patient with POD three months and one year after their surgery intervention. The aim of Telephone or Video or questionnaire Follow up is to assess to present Neurocognitive disorder (NCD).The Follow up screening tool is based on DSM 5 diagnostic criteria for "mild cognitive disorder". If one of the diagnostic criteria applies, we recommend to visit a neuropsychologist/ memory clinic recommend to visit a neuropsychologist/ memory clinic.
Time frame: Up to three months
Depression
Depression is measured by Patient Health Questionnaire-8 (PHQ-8).This scale encompasses eight questions, which can be answered with not at all (0), several days (1), more than half the days (2) and nearly every day (3). The score is the sum of the 8 items. The minimum score is 0 (best outcome) and the heights 24 (worse outcome).
Time frame: Up to one year
Anxiety
Anxiety is measured by Generalized Anxiety Disorder Scale-7 (GAD-7).The Assessment method has seven items; each can be answered with not at all (0), several days (1), more than half the days (2) and nearly every day (3). The score is the sum of all items. The minimum and maximum score are 0 (better outcome) and 21 (worse outcome) respectively.
Time frame: Up to one year
Physical function
Physical health is measured by the sum scores of the following outcome measurement instruments: Timed Up-and-Go (TUG), Handgrip Strength, 2-Minute Walk Test (2-MWT), Short Physical Performance Battery (SPPB).
Time frame: Up to one year
Intensive care unit length of stay
Intensive care unit length of stay is measured in days
Time frame: Participants will be followed for the duration of intensive care stay, an expected average of 2 days
Hospital length of stay
Hospital length of stay is measured in days
Time frame: The participants are followed up until the end of hospital stay, an expected average of 7 days
Pain levels
Pain levels are measured with validated subjective/objective pain scores.
Time frame: Up to one year
Disability 1
Disability 1 is measured by Instrumental activities of daily living scale.This scale has 8 categories (ability to use telephone, shopping, food preparation, housekeeping, laundry, mode of transportation, responsibility for own medications, ability to handle finances). Each has different levels of functioning with a score assigned. The patient circles the item that most closely describes its functional level. The lowest score is 0 (better outcome) and the highest is 8 (worse outcome).
Time frame: Up to one year
Disability 2
Disability 2 is measured by Timed up and go test.
Time frame: Up to one year
Disability 3
Disability 3 is measured by hand grip strength test
Time frame: Up to one year
Anxiety-Score
Faces Anxiety Scale score
Time frame: Up to one year
Sedation
Sedation is measured with the Richmond Agitation and Sedation Scale (RASS)
Time frame: Up to one year
Person's level of consciousness
The Glasgow Coma Scale (GCS) is a clinical scale used to reliably measure a person's level of consciousness after a brain injury. The GCS assesses a person based on their ability to perform eye movements, speak, and move their body. These three behaviors make up the three elements of the scale: eye, verbal, and motor. A person's GCS score can range from 3 (completely unresponsive) to 15 (responsive). This score is used to guide immediate medical care after a brain injury (such as a car accident) and also to monitor hospitalized patients and track their level of consciousness. Lower GCS scores are correlated with higher risk of death.
Time frame: The participants are followed up until the end of hospital stay, an expected average of 7 days
Permanent medication
Medication at three months compared to baseline is assessed.
Time frame: Up to one year
Frailty status
Frequency of frailty is measured by modified Fried criteria (category 1 +2 = pre-frail, category 3 -5 = frail)
Time frame: Up to one year
Postoperative oral ingestion
Ingestion is measured by the amount of fluids and solid food.
Time frame: The participants are followed up until the end of hospital stay, an expected average of 7 days
Barthelindex
Score of the Barthel Index ranging from 0 to 100 were collected when 0 is the minimum (worst outcome) and 100 is the maximum (best outcome). Score was reported as mean score of the Barthel Index.
Time frame: Up to one year
Patient-related outcome measures (PROMS)
Different tools and questionnaires are combined to measure Patient-related outcome.
Time frame: Up to one year
Patient-related experience measures (PREMS)
Patient-reported experiences of health care are measured with a questionnaire.
Time frame: Up to one year
Therapy recommendations
Therapy recommendations are documented from patient records.
Time frame: Up to one year
Survival
Survival is measured in Patients form QV-POD-2 within 1 year; Survival is measured in patients from QV-POD-1 until 3 months (addendum to the secondary outcome measures from the ethics amendment vote of 28/08/2025).
Time frame: Up to one year
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