Delirium - Postoperative, Frailty, Postoperative Care in Geriatric Intensive Care Patients, Postoperative Pain
Conditions
Keywords
Geriatric, Intensive Care Unit, Major Surgery, Postoperative Analgesia, Early Mobilization, Epidural Analgesia, Peripheral Nerve Block, Opioid Consumption, Delirium, CAM-ICU, Patient Satisfaction, Frailty
Brief summary
This study looks at how different pain-control methods affect how quickly older adults get out of bed and start moving again after major surgery. Researchers will observe patients aged 65 and older who are admitted to the intensive care unit (ICU) after major surgery. Doctors will use their usual pain-control methods - either medication given through a vein, an epidural, or a nerve block - based on standard clinical practice; the study team will not change or choose the treatment. The study will record how long it takes for each patient to first sit up, stand, or walk after surgery, along with pain levels, confusion (delirium), how satisfied patients are with their pain control, and how long they stay in the ICU. The goal is to better understand which pain-control approaches may help older patients recover and move more quickly and safely after major surgery.
Detailed description
Early mobilization is a key component of enhanced postoperative recovery in older adults and has been associated with reduced functional decline, shorter intensive care unit (ICU) and hospital stays, and fewer postoperative complications. However, postoperative pain remains one of the main barriers to early mobilization. Although several analgesic strategies are routinely used after major surgery, their comparative effects on functional recovery in critically ill geriatric patients have not been well established in real-world clinical practice. This is a prospective, single-center observational cohort study designed to evaluate the association between routinely administered postoperative analgesic techniques and early postoperative recovery in geriatric surgical patients requiring ICU admission. Because the study is observational, all perioperative and postoperative management, including the choice of analgesic technique, will be determined exclusively by the treating clinicians according to institutional practice. No treatment allocation, randomization, or protocol-driven intervention will be performed. Clinical and perioperative data will be collected prospectively from routine medical records, anesthesia documentation, ICU electronic records, and nursing charts using standardized case report forms. Data quality will be ensured through predefined data collection procedures and verification before database entry. The study does not require any additional diagnostic tests, invasive procedures, blood sampling, or alterations to routine patient care. The findings are expected to provide real-world evidence regarding the relationship between commonly used postoperative analgesic strategies and recovery after major surgery in older adults. These results may help optimize perioperative pain management protocols and support future comparative and interventional studies aimed at improving functional recovery in the geriatric surgical population.
Interventions
DRUGSystemic Opioid Analgesia (± Multimodal)
Standard-of-care intravenous opioid-based analgesia, with or without additional non-opioid multimodal agents, administered per routine clinical practice.
PROCEDUREEpidural Analgesia
Standard-of-care epidural analgesia administered per routine clinical practice.
PROCEDUREPeripheral Nerve Block (± Multimodal)
Standard-of-care peripheral nerve block analgesia, with or without additional non-opioid multimodal agents, administered per routine clinical practice.
Sponsors
Prof. Dr. Cemil Tascıoglu Education and Research Hospital Organization
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 65 years or older * ASA physical status classification I-IV * Admitted to the intensive care unit (ICU) following major surgery * ICU stay of at least 24 hours
Exclusion criteria
* Previously diagnosed advanced-stage dementia * Inability to assess consciousness due to severe neurological deficit * ICU stay of less than 24 hours * Incomplete or insufficient clinical data
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to First Mobilization | From ICU admission until first achievement of ICU Mobility Scale level ≥1, assessed for up to 30 days. | Time (in hours) from ICU admission to the first time the patient achieves at least one level of mobilization - sitting at the bedside, standing, or walking - based on the ICU Mobility Scale. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Score | At ICU admission, and at 6, 12, 24, and 48 hours after ICU admission | Pain intensity assessed using the Numeric Rating Scale (0 = no pain, 10 = worst possible pain). |
| Incidence of Delirium | Assessed at least once daily for the first 3 days of ICU stay | Presence of delirium assessed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), reported as positive or negative. |
| Length of ICU Stay | From ICU admission to ICU discharge, up to approximately 30 days | Total number of days the patient remains in the intensive care unit. |
| Total Opioid Consumption | From ICU admission to ICU discharge, up to approximately 30 days | Cumulative opioid dose administered, expressed as morphine milligram equivalents (mg). |
| Patient Satisfaction with Analgesia | Assessed once, prior to ICU discharge | Patient-reported satisfaction with pain management assessed using a 5-point Likert scale (1 = very dissatisfied, 5 = very satisfied). |
| Incidence and Type of Postoperative Complications | From ICU admission to ICU discharge, up to approximately 30 days | Presence and type of any postoperative complications recorded during ICU stay. |
Countries
Turkey (Türkiye)
Contacts
CONTACTZekeriya Ervatan, MD
Outcome results
None listed