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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 withBackground 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.show moreshow less

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Metadaten
Author: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 A. RappGND
DOI:https://doi.org/10.1186/s13063-018-3148-8
ISSN:1468-6694
ISSN:1745-6215
ISSN:1468-6708
Parent Title (English):Trials
Subtitle (English):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)
Publisher:BioMed Central
Place of publication:London
Document Type:Article
Language:English
Date of first Publication:2019/01/21
Year of Completion:2019
Release Date:2019/02/20
Tag:Cost-effectiveness; Cross-sectoral care; Delirium prevention; Dementia; Elective surgery; Older patients; Postoperative cognitive dysfunction; Quality of life
Volume:20
Issue:71
Pagenumber:15
Funder:Universität Potsdam
Grant Number:PA 2019_13
Organizational units:Humanwissenschaftliche Fakultät / Strukturbereich Kognitionswissenschaften
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Peer Review:Referiert
Grantor:Publikationsfonds der Universität Potsdam
Publication Way:Open Access
Licence (German):License LogoCreative Commons - Namensnennung, 4.0 International
Notes extern:Zweitveröffentlichung in der Schriftenreihe Postprints der Universität Potsdam : Humanwissenschaftliche Reihe ; 535