The Potential Value of Prehabilitation for Preventing Delirium in Elective Surgery for Aneurysms of the Abdominal Aorta

IF 3.6 3区医学

Clinical Interventions in Aging Pub Date : 2024-01-09 DOI:10.2147/cia.s420861

Anne Lise Meulenbroek, Ewout W Steyerberg, Ties L Janssen, Stefanie R van Mil, Miriam C Faes, Lijckle van der Laan

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引用次数: 0

Abstract

Objective: Delirium is a common and serious postoperative complication in elderly patients undergoing abdominal aortic aneurysm (AAA) repair and is associated with a variety of adverse outcomes. Multimodal prehabilitation aims to identify and minimize potential risk factors for delirium and improve overall health. The aim of this study is to investigate the effect of multimodal prehabilitation on delirium incidence in elderly patients undergoing elective repair for AAA.
Methods: A single-centre cohort analysis was performed in the Netherlands for patients aged ≥ 70 years, undergoing elective repair for AAA (open surgery and endovascular aortic repair). Prehabilitation was gradually introduced between 2016 and 2019 and offered as standard care from 2019. The program was constructed to optimize overall health and included delirium risk assessment, home-based tailor-made exercises by a physical therapist, nutritional optimization by a dietician, iron infusion in case of anaemia and a comprehensive geriatric assessment by a geriatrician in case of frailty. The primary outcome was incidence of delirium within 30 days after surgery.
Results: A total of 81 control and 123 prehabilitation patients were included. A reduction in incidence of delirium was found (11.1% in the control group to 4.9% in the prehabilitation group), with too small numbers to reach statistical significance (p=0.09). Also, patients in the prehabilitation group had a small, non-significant decreased length of hospital stay (4 days) compared to the control group (5 days) (p=0.07).
Conclusion: Although no significant differences were found, we carefully conclude that this study provides some support for implementing multimodal prehabilitation for delirium prevention in elderly patients undergoing AAA repair. Further research with larger cohorts is necessary to identify and select patients that would most benefit from prehabilitation.

Plain Language Summary: Delirium is a common complication in elderly patients after undergoing abdominal aortic aneurysm (AAA) repair. Delirium is associated with a prolonged hospital-stay, decreased quality of life and increased mortality. To prevent delirium it is important to identify possible risk factors and assess the patients’ overall fitness. This is best done preoperatively, since the patient is not yet recovering from a major surgery. This is called “prehabilitation”.
In this study, we investigated the effect of multimodal prehabilitation in patients undergoing surgery for an AAA. The program consists of:Individual delirium risk-assessment,Personalized home-based tailor-made exercises,Nutritional optimization,Iron infusion in case of anaemia, andA comprehensive geriatric assessment by a geriatrician in case of frailty.
Eighty-one control and 123 prehabilitation patients were included. A reduction in incidence of delirium was found (11.1% control to 4.9% prehabilitation), with too small numbers to reach statistical significance (p=0.09). Also, patients in the prehabilitation group had a small, non-significant decreased length of stay (4 days) compared to the control group (5 days) (p=0.07).
Prehabilitation may be effective in preventing delirium in elderly patients undergoing AAA repair. Further research is necessary to identify and select patients that would most benefit from prehabilitation.

Keywords: aneurysm of the abdominal aorta, prehabilitation, preoperative rehabilitation, delirium, delirium/prevention and control

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预防腹主动脉瘤择期手术中谵妄的潜在康复价值

目的：谵妄是接受腹主动脉瘤（AAA）修补术的老年患者常见的严重术后并发症，与多种不良后果相关。多模式术前康复的目的是识别并尽量减少谵妄的潜在风险因素，改善整体健康状况。本研究旨在探讨多模式预康复对接受 AAA 选择性修复术的老年患者谵妄发生率的影响：在荷兰对年龄≥70岁、接受AAA择期修复术（开放手术和血管内主动脉修复术）的患者进行了单中心队列分析。预康复在2016年至2019年期间逐步引入，并从2019年起作为标准护理提供。该计划旨在优化整体健康，包括谵妄风险评估、理疗师上门量身定制的运动、营养师的营养优化、贫血患者的铁剂输注以及老年病学家对虚弱患者的全面老年病学评估。主要结果是术后 30 天内的谵妄发生率：结果：共纳入了 81 名对照组和 123 名康复前患者。发现谵妄发生率有所下降（对照组为 11.1%，康复前组为 4.9%），但由于人数太少，无法达到统计学意义（P=0.09）。此外，与对照组（5 天）相比，康复前治疗组患者的住院时间（4 天）略有减少，但无显著性差异（P=0.07）：虽然没有发现明显的差异，但我们谨慎地得出结论：本研究为在接受 AAA 修复术的老年患者中实施多模式预康复以预防谵妄提供了一些支持。有必要对更大规模的队列进行进一步研究，以确定和选择最能从康复训练中受益的患者。白话摘要：谵妄是老年患者接受腹主动脉瘤（AAA）修复术后常见的并发症。谵妄与住院时间延长、生活质量下降和死亡率增加有关。要预防谵妄，重要的是识别可能的风险因素并评估患者的总体健康状况。这项工作最好在术前进行，因为病人尚未从大手术中恢复过来。在这项研究中，我们调查了多模式术前康复对接受 AAA 手术的患者的影响。该计划包括：个人谵妄风险评估、基于家庭的个性化定制运动、营养优化、贫血患者的铁剂输注，以及老年病学家对体弱患者的全面老年病学评估。结果发现，谵妄发生率有所下降（对照组为 11.1%，康复前为 4.9%），但由于人数太少，无法达到统计学意义（P=0.09）。此外，康复前组患者的住院时间（4 天）比对照组（5 天）略有减少，但无显著性差异（P=0.07）。有必要开展进一步研究，以确定和选择最能从预康复中获益的患者。关键词：腹主动脉瘤；预康复；术前康复；谵妄；谵妄/预防和控制

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来源期刊

Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-

CiteScore

6.20

自引率

2.80%

发文量

193

期刊介绍： Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.