Improvement of Perioperative Care of Elderly Patients

NCT ID: NCT03325413

Last Updated: 2021-05-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

310 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-11-01

Study Completion Date

2020-05-14

Brief Summary

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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.

Detailed Description

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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.

Conditions

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Perioperative Care

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SEQUENTIAL

The study has 3 arms with patients allocated to them in a fixed chronological order.

For six months, patients will be recruited for the control arm. In this arm, participants receive usual care without any additional intervention initiated by the study.

After finishing recruitment for the control arm, patients will be recruited for the implementation arm for six months. In this arm, stepwise implementation of the study interventions begins with the possibility of flexibly adapting them to the specific conditions.

After finishing recruitment for the implementation arm, patients will be recruited for the full-scale intervention arm for six months. In this arm, all study interventions will be utilized.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Control

Usual care with assessment only (no study-related intervention)

Group Type NO_INTERVENTION

No interventions assigned to this group

Implementation

Implementation of intervention measures

Group Type OTHER

Systematic inclusion of family members

Intervention Type BEHAVIORAL

Systematic inclusion of family members/ reference person in the perioperative process

Preoperative information

Intervention Type BEHAVIORAL

Detailed preoperative information about delirium prevention and procedures

Physical and breathing exercises

Intervention Type BEHAVIORAL

Preoperative execution of physical and breathing exercises if necessary

Dietary supplements

Intervention Type DIETARY_SUPPLEMENT

Dietary supplements if necessary

Evaluation of long-term medication

Intervention Type OTHER

Avoidance of unsuitable drugs for elderly if possible

Regional anesthesia

Intervention Type PROCEDURE

Regional anesthesia whenever possible

Personal aids

Intervention Type OTHER

Personal orientation aids until anesthesia induction

Temperature management

Intervention Type DEVICE

Perioperative warming

Neurmonitoring

Intervention Type DEVICE

Using Bispectral index (BIS) to measure the depth of anesthesia

Pain catheter

Intervention Type PROCEDURE

A pain catheter will be used as postoperative pain therapy if possible

Full-scale intervention

Group Type OTHER

Systematic inclusion of family members

Intervention Type BEHAVIORAL

Systematic inclusion of family members/ reference person in the perioperative process

Preoperative information

Intervention Type BEHAVIORAL

Detailed preoperative information about delirium prevention and procedures

Physical and breathing exercises

Intervention Type BEHAVIORAL

Preoperative execution of physical and breathing exercises if necessary

Dietary supplements

Intervention Type DIETARY_SUPPLEMENT

Dietary supplements if necessary

Evaluation of long-term medication

Intervention Type OTHER

Avoidance of unsuitable drugs for elderly if possible

Regional anesthesia

Intervention Type PROCEDURE

Regional anesthesia whenever possible

Personal aids

Intervention Type OTHER

Personal orientation aids until anesthesia induction

Temperature management

Intervention Type DEVICE

Perioperative warming

Neurmonitoring

Intervention Type DEVICE

Using Bispectral index (BIS) to measure the depth of anesthesia

Pain catheter

Intervention Type PROCEDURE

A pain catheter will be used as postoperative pain therapy if possible

Interventions

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Systematic inclusion of family members

Systematic inclusion of family members/ reference person in the perioperative process

Intervention Type BEHAVIORAL

Preoperative information

Detailed preoperative information about delirium prevention and procedures

Intervention Type BEHAVIORAL

Physical and breathing exercises

Preoperative execution of physical and breathing exercises if necessary

Intervention Type BEHAVIORAL

Dietary supplements

Dietary supplements if necessary

Intervention Type DIETARY_SUPPLEMENT

Evaluation of long-term medication

Avoidance of unsuitable drugs for elderly if possible

Intervention Type OTHER

Regional anesthesia

Regional anesthesia whenever possible

Intervention Type PROCEDURE

Personal aids

Personal orientation aids until anesthesia induction

Intervention Type OTHER

Temperature management

Perioperative warming

Intervention Type DEVICE

Neurmonitoring

Using Bispectral index (BIS) to measure the depth of anesthesia

Intervention Type DEVICE

Pain catheter

A pain catheter will be used as postoperative pain therapy if possible

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Age \>64 years
* Written informed patients consent
* forthcoming elective surgery
* Time interval from inclusion to appointed surgery at least 5 days

Exclusion Criteria

* Refusal of consent
* Illiteracy
* Poor knowledge ofGerman language
* Mental disability
* Vision handicap (not corrected)
* Hearing handicap (not corrected)
* Benzodiazepine abuse
* Drug/ substance abuse
* Psychosis
* Parkinson disease
* Emergency surgery
* Planned postoperative ICU treatment
* Planned inpatient stay 1 night
* Cerebral surgery
* Ophthalmological surgery
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Universitätsklinikum Hamburg-Eppendorf

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf (UKE)

Hamburg, , Germany

Site Status

Countries

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Germany

References

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Olotu C, Lebherz L, Mende A, Hempel C, Philipp R, Schroeter J, Plumer L, Koch B, Harter M, Zollner C, Kriston L, Kiefmann R. Feasibility and effectiveness of an evidence-based intervention bundle to improve peri-operative care of older adults: A quality improvement study. Eur J Anaesthesiol Intensive Care. 2024 Jul 4;3(4):e0055. doi: 10.1097/EA9.0000000000000055. eCollection 2024 Aug.

Reference Type DERIVED
PMID: 39917250 (View on PubMed)

Olotu C, Lebherz L, Harter M, Mende A, Plumer L, Goetz AE, Zollner C, Kriston L, Kiefmann R. Improvement of perioperative care of the elderly patient (PeriAge): protocol of a controlled interventional feasibility study. BMJ Open. 2019 Nov 24;9(11):e031837. doi: 10.1136/bmjopen-2019-031837.

Reference Type DERIVED
PMID: 31767591 (View on PubMed)

Other Identifiers

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01VSF16057

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

PV5596

Identifier Type: -

Identifier Source: org_study_id

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