42487
2019
2019
eng
15
71
20
article
BioMed Central
London
1
2019-01-21
2019-01-21
--
Patient safety, cost-effectiveness, and quality of life
Background
Postoperative delirium is a common disorder in older adults that is associated with higher morbidity and mortality, prolonged cognitive impairment, development of dementia, higher institutionalization rates, and rising healthcare costs. The probability of delirium after surgery increases with patients’ age, with pre-existing cognitive impairment, and with comorbidities, and its diagnosis and treatment is dependent on the knowledge of diagnostic criteria, risk factors, and treatment options of the medical staff. In this study, we will investigate whether a cross-sectoral and multimodal intervention for preventing delirium can reduce the prevalence of delirium and postoperative cognitive decline (POCD) in patients older than 70 years undergoing elective surgery. Additionally, we will analyze whether the intervention is cost-effective.
Methods
The study will be conducted at five medical centers (with two or three surgical departments each) in the southwest of Germany. The study employs a stepped-wedge design with cluster randomization of the medical centers. Measurements are performed at six consecutive points: preadmission, preoperative, and postoperative with daily delirium screening up to day 7 and POCD evaluations at 2, 6, and 12 months after surgery. Recruitment goals are to enroll 1500 patients older than 70 years undergoing elective operative procedures (cardiac, thoracic, vascular, proximal big joints and spine, genitourinary, gastrointestinal, and general elective surgery procedures.
Discussion
Results of the trial should form the basis of future standards for preventing delirium and POCD in surgical wards. Key aims are the improvement of patient safety and quality of life, as well as the reduction of the long-term risk of conversion to dementia. Furthermore, from an economic perspective, we expect benefits and decreased costs for hospitals, patients, and healthcare insurances.
Trial registration
German Clinical Trials Register, DRKS00013311. Registered on 10 November 2017.
Trials
reduction of delirium risk and postoperative cognitive dysfunction after elective procedures in older adults—study protocol for a stepped-wedge cluster randomized trial (PAWEL Study)
10.1186/s13063-018-3148-8
1468-6694
1745-6215
1468-6708
Universität Potsdam
PA 2019_13
1661.24
<a href="http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-424883">Zweitveröffentlichung in der Schriftenreihe Postprints der Universität Potsdam : Humanwissenschaftliche Reihe ; 535</a>
CC-BY - Namensnennung 4.0 International
Alba Sánchez
Christine Thomas
Friederike Deeken
Sören Wagner
Stefan Klöppel
Felix Kentischer
Chrstine A. F. von Arnim
Michael Denkinger
Lars O. Conzelmann
Janine Biermann-Stallwitz
Stefanie Joos
Heidrun Sturm
Brigitte Metz
Ramona Auer
Yoanna Skrobik
Gerhard W. Eschweiler
Michael Armin Rapp
eng
uncontrolled
Cross-sectoral care
eng
uncontrolled
Delirium prevention
eng
uncontrolled
Postoperative cognitive dysfunction
eng
uncontrolled
Dementia
eng
uncontrolled
Older patients
eng
uncontrolled
Elective surgery
eng
uncontrolled
Quality of life
eng
uncontrolled
Cost-effectiveness
Medizin und Gesundheit
open_access
Strukturbereich Kognitionswissenschaften
Referiert
Publikationsfonds der Universität Potsdam
Open Access
42488
2019
2019
eng
15
535
postprint
1
2019-02-20
2019-02-20
--
Patient safety, cost-effectiveness, and quality of life
Background
Postoperative delirium is a common disorder in older adults that is associated with higher morbidity and mortality, prolonged cognitive impairment, development of dementia, higher institutionalization rates, and rising healthcare costs. The probability of delirium after surgery increases with patients’ age, with pre-existing cognitive impairment, and with comorbidities, and its diagnosis and treatment is dependent on the knowledge of diagnostic criteria, risk factors, and treatment options of the medical staff. In this study, we will investigate whether a cross-sectoral and multimodal intervention for preventing delirium can reduce the prevalence of delirium and postoperative cognitive decline (POCD) in patients older than 70 years undergoing elective surgery. Additionally, we will analyze whether the intervention is cost-effective.
Methods
The study will be conducted at five medical centers (with two or three surgical departments each) in the southwest of Germany. The study employs a stepped-wedge design with cluster randomization of the medical centers. Measurements are performed at six consecutive points: preadmission, preoperative, and postoperative with daily delirium screening up to day 7 and POCD evaluations at 2, 6, and 12 months after surgery. Recruitment goals are to enroll 1500 patients older than 70 years undergoing elective operative procedures (cardiac, thoracic, vascular, proximal big joints and spine, genitourinary, gastrointestinal, and general elective surgery procedures.
Discussion
Results of the trial should form the basis of future standards for preventing delirium and POCD in surgical wards. Key aims are the improvement of patient safety and quality of life, as well as the reduction of the long-term risk of conversion to dementia. Furthermore, from an economic perspective, we expect benefits and decreased costs for hospitals, patients, and healthcare insurances.
Trial registration
German Clinical Trials Register, DRKS00013311. Registered on 10 November 2017.
Postprints der Universität Potsdam Humanwissenschaftliche Reihe
reduction of delirium risk and postoperative cognitive dysfunction after elective procedures in older adults—study protocol for a stepped-wedge cluster randomized trial (PAWEL Study)
10.25932/publishup-42488
urn:nbn:de:kobv:517-opus4-424883
1866-8364
Trials 20 (2019) Nr. 71 DOI: 10.1186/s13063-018-3148-8
<a href="http://publishup.uni-potsdam.de/opus4-ubp/frontdoor/index/index/docId/42487">Bibliographieeintrag der Originalveröffentlichung/Quelle</a>
true
true
CC-BY - Namensnennung 4.0 International
Alba Sánchez
Christine Thomas
Friederike Deeken
Sören Wagner
Stefan Klöppel
Felix Kentischer
Chrstine A. F. von Arnim
Michael Denkinger
Lars O. Conzelmann
Janine Biermann-Stallwitz
Stefanie Joos
Heidrun Sturm
Brigitte Metz
Ramona Auer
Yoanna Skrobik
Gerhard W. Eschweiler
Michael Armin Rapp
Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe
535
eng
uncontrolled
Cross-sectoral care
eng
uncontrolled
Delirium prevention
eng
uncontrolled
Postoperative cognitive dysfunction
eng
uncontrolled
Dementia
eng
uncontrolled
Older patients
eng
uncontrolled
Elective surgery
eng
uncontrolled
Quality of life
eng
uncontrolled
Cost-effectiveness
Medizin und Gesundheit
open_access
Strukturbereich Kognitionswissenschaften
Referiert
Open Access
Universität Potsdam
https://publishup.uni-potsdam.de/files/42488/phr535.pdf