Elective major procedures:o primary knee or hip endoprosthesiso Knee/hip replacement (aseptic/septic)o Spinal interventionsSelective decompression (spinal intervention without instrumentation) One- and two-segment spondylodesistri- and multisegmental spondylodesisKyphoplasty
Conditions
Interventions
Group 1: With geriatrician and CGA-guided intervention: intervention group (early preoperative involvement of geriatrician with CGA-guided intervention including postoperative further specialist follo
Sponsors
Direktor der Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Inhaber des Lehrstuhls für Orthopädie/Unfallchirurgie an der Rheinischen Friedrich-Wilhelms-Universität Bonn Klinik und Poliklinik für Orthopädie und Unfallchirurgie
Eligibility
Sex/Gender
All
Age
70 Years to No maximum
Inclusion criteria
Inclusion criteria: - Patients of the clinic for orthopedics - =70 years - Elective major procedures: o primary knee or hip arthroplasty o Knee/hip arthroplasty exchange (aseptic/septic) o Spinal interventions Selective decompression (spinal intervention without instrumentation) One- and two-segment spondylodesis tri- and multisegmental spondylodesis Kyphoplasty - Geriatric-type multimorbidity (=3 diseases) - Polypharmacy (=5 medications) - ISAR =2
Exclusion criteria
Exclusion criteria: - (Planned) geriatric complex treatment (if necessary also exclusion of patients in the course!) - Disease in final stage - Severe/advanced dementia (MMSE<10) - Lack of consent (self or by proxy or guardian) - Lack of guardian or authorized representative with MMSE < 18 (up to an MMSE of 18 - i.e. a slight cognitive impairment - it can usually still be assumed that there is capacity to act)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| SPPB (Short Physical Performance Battery: balance, walking speed, five-chair rise). 1. Preoperatively 2. at the time of discharge 3. 4 months postoperatively 4. 12 months postoperatively Success is considered to have been achieved if, as a result of the intervention (involvement of a geriatrician and use of the Comprehensive Geriatric Assessment), the mean SPPB 4 months after hospital discharge is 0.74 points greater than in the control group. | — |
Secondary
| Measure | Time frame |
|---|---|
| - Function (TUG, Esslingen Transfer Scale) - Ability to help oneself (ADL) - Frailty (FRESH screening instrument) - Cognition (MMSE) - Emotion (GDS) - Delirium (4AT, if positive CAM) - Pain (VRS) - Length of inpatient stay - mortality - Nursing home admission - "Days at home" - Discharge with a higher level of care - Re-hospitalization - Costs and cost-effectiveness - Risks and postoperative complications (intensive care stay), vascular complications (myocardial infarction with and without cardiac decompensation, apoplexy, deep vein thrombosis and pulmonary embolism) severe infections (pneumonia), acute renal failure and delirium) - Control of medication specific to indication (delirium treatment, pain treatment, osteoporosis). - Specific orthopedic assessments: (from the discharge letter!) - Harris Hip Score - Knee Society Score - PBM measures (documentation of patient blood management measures). - CBC as part of routine blood draws and determination of inflammatory markers (soluble factors and cell populations) | — |
Countries
Germany
Contacts
Public ContactAlbert Lukas
St. Martinus-Krankenhaus Düsseldorf
Outcome results
None listed