Complication, Postoperative, Perioperative/Postoperative Complications
Conditions
Keywords
Physiotherapy, Inspiratory Muscle Training, Perioperative Medicine, Postoperative outcomes, Preoperative nutrition, Elderly, frail
Brief summary
This study aims to study the efficacy of a preoperative bundle of interventions, which consists of preoperative physiotherapy, nutritional support and cognitive exercises on elderly frail patients undergoing major abdominal surgery, and evaluating their outcomes. There will be two arms, intervention and control.
Detailed description
Frailty is a geriatric syndrome, defined as an increased vulnerability to stressors leading to a state of decreased physiological resistance. It is characterised by a constellation of symptoms and signs that describe the heterogeneous response of older adults to physiological and metabolic challenges. While frailty is not necessarily synonymous with chronological age, it is more prevalent among the older adult population and is associated with up to a threefold increased risk of mortality or major morbidity postsurgery. Thus, it has become critically important for healthcare systems to develop strategies designed to improve clinical outcomes in this high-risk population when undergoing surgeries. Currently there is no clear intervention that has been proven to modify the syndrome of frailty or its impact on postoperative outcomes. This study investigates a novel multidisciplinary approach that can be implemented within a short time frame prior to surgery. We plan to study the efficacy of a preoperative bundle of interventions, which consists of preoperative physiotherapy, nutritional support and cognitive exercises on elderly frail patients undergoing major abdominal surgery, and evaluating their outcomes based 1) length of hospital stay 2) Functional recovery from surgery 3) post-operative complications.
Interventions
DIETARY_SUPPLEMENTEnsure, Resource 2.0 and Glucerna
Preoperative nutritional supplement for undernourished patients
OTHERCognitive Training, Memory Card Game
Preoperative memory card game
DEVICE'Threshold' Inspiratory Muscle Trainer, Respironics of New Jersey Inc
Inspiratory muscle trainer protocol for strengthening respiratory muscles
Sponsors
Singapore General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
1. Patients attending the Preoperative Evaluation Clinic, SGH at least 11 days prior to his/her elective major abdominal surgery. Major abdominal surgery is defined as an intraperitoneal surgery with expected length of stay beyond 2 days. For patients who attended the clinic more than 11 days prior to surgery date, they will be informed to start their prehabilitation bundle 10 days prior to surgery. 2. Aged 65 and above 3. Diagnosed as frail based on Fried criteria score 3and above 4. Able to understand and follow the prescribed cognitive and physical exercise
Exclusion criteria
1. Patients with Parkinson disease, previous stroke, neuromuscular disorders and those taking carbidopa/levodopa, donepezil hydrochloride or antidepressants as previous studies have found that these medications may cause symptoms that are similar with domains of frailty. 2. Patients who are not able to communicate
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Length of Hospital Stay | Will be compared between the intervention and control arms for up to 1 year |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Post operative complications | Duration of hospital admission for up to 30 days | mortality, Intensive Care Unit (ICU) stay, reintubation and ventilation days in ICU, Acute Myocardial Infarction, new arrhythmia. |
| Functional Post Operative Recovery | Duration of hospital admission for up to 30 days | Postoperative Quality of Recovery Scale (PQRS) questionnaire at 4 time points (Day of surgery, Postoperative days 1, 3 and 7) throughout their surgical admissions |
Countries
Singapore
Contacts
Primary ContactHairil R Abdullah, MBBS
Outcome results
None listed