F05.8
Conditions
Interventions
Group 1: First Project Phase (Control Phase)
1. Control Group (A)
i. MoCA test score < 26 points
ii. Standard-of-care medication review + screening for drugs associated with delirium
iii.
Sponsors
Universität Marburg Fachbereich Medizin / Pharmazie
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Inclusion criteria
Inclusion criteria: Inclusion Criteria • Age > 65 years • Planned surgical procedure in a specialized discipline (General and Visceral Surgery, Urology/Obstetrics and Gynecology, Gynecology, Urology) • Postoperative care in a surgical ICU/IMC • At least 3 medications in the patient’s long-term regimen at the time of admission Surgical Procedures for Inclusion in the Study General and Visceral Surgery (AVC) • Esophageal resection • Total or subtotal gastrectomy • Pancreaticoduodenectomy (Whipple procedure) • Hemihepatectomy or extended liver resections • Colectomy • Deep anterior rectal resection • Bariatric surgery (e.g., sleeve gastrectomy, gastric bypass) Orthopedics / Trauma Surgery (U/O) • Joint replacement of major joints: total hip replacement (THR), total knee replacement (TKR), total shoulder replacement (TSR) • Revision arthroplasty (e.g., due to infection or prosthesis loosening) • Management of complex pelvic fractures • Multifragmentary proximal humerus or femur fractures with osteosynthesis • Corrective osteotomies for axial deformities Urology (URO) • Radical prostatectomy (open or robot-assisted) • Radical cystectomy (with neobladder or ileal conduit) • Radical or partial nephrectomy / nephroureterectomy • Retroperitoneal lymphadenectomy • Ureter reconstruction or urinary diversion Gynecology (GYN) • Radical hysterectomy • Pelvic exenteration • Abdominal myomectomy • Oophorectomy with omentectomy and pelvic lymphadenectomy • Laparotomy for severe adhesions or endometriosis • Tumor debulking for advanced ovarian cancer
Exclusion criteria
Exclusion criteria: Exclusion Criteria • Lack of consent to participate in the study • History of delirium • Patients with a designated guardian for medical affairs • Conditions that could influence delirium screening: • Alcoholism (daily alcohol consumption) • Withdrawal symptoms (currently present) • Encephalopathies • Cerebral hemorrhages/strokes – with residual effects within the past 12 months • Hepatic insufficiency – CHILD B/C • Language barriers that prevent administration of the MoCA/ICDSC • Emergency surgeries • Pre-existing memory/coordination disorders of the hands that make it impossible to administer the MoCA score (e.g., uncontrollable tremors, paralysis) • Insufficient documentation of the data required for evaluation • Ongoing medical indication for sedation/invasive ventilation (more than 72 hours postoperatively)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Medical: • Reduction in the incidence of delirium through a multimodal treatment approach compared to the control group Pharmaceutical: • Improvement in medication safety (AMTS) through a reduction in the proportion of delirium-inducing medications relative to total medication use, achieved through clinical-pharmaceutical interventions | — |
Secondary
| Measure | Time frame |
|---|---|
| Medical: • Length of stay in the intermediate care/intensive care unit • Length of hospital stay • Factors influencing the implementation of the MoCA at patient admission • Training duration (in minutes) • Effort required for implementation (training planning in hours) Pharmaceutical: • Improved adherence to the implementation of the developed institutional standard for the treatment of delirium • Improved adherence by treating surgeons to clinical-pharmaceutical medication recommendations • Reduction in medication-related problems (MRPs) through clinical medication management | — |
Countries
Germany
Contacts
Public ContactCarina Hohmann
Klinikum Fulda
Outcome results
None listed