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Long-term outcomes of major abdominal surgery and postoperative delirium after multimodal prehabilitation of older patients

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Abstract

Purpose

The long-term outcomes of surgery followed by delirium after multimodal prehabilitation program are largely unknown. We conducted this study to assess the effects of prehabilitation on 1-year mortality and of postoperative delirium on 1-year mortality and functional outcomes.

Methods

The subjects of this study were patients aged ≥ 70 years who underwent elective surgery for abdominal aortic aneurysm (AAA) or colorectal cancer (CRC) between January 2013, and June 2018. A prehabilitation program was implemented in November 2015, which aimed to optimize physical health, nutritional status, factors of frailty and preoperative anemia prior to surgery. The outcomes were assessed as mortality after 6 and 12 months, compared between the two treatment groups; and mortality and functional outcomes, compared between patients with and those without delirium.

Results

There were 627 patients (controls N = 360, prehabilitation N = 267) included in this study. Prehabilitation did not reduce mortality after 1 year (HR 1.31 [95% CI 0.75–2.30]; p = 0.34). Delirium was significantly associated with 1-year mortality (HR 4.36 [95% CI 2.45–7.75]; p < 0.001) and with worse functional outcomes after 6 and 12 months (KATZ ADL p = 0.013 and p = 0.004; TUG test p = 0.041 and p = 0.011, respectively).

Conclusions

The prehabilitation program did not reduce 1-year mortality. Delirium and the burden of comorbidity are both independently associated with an increased risk of 1-year mortality and delirium is associated with worse functional outcomes.

Trial registration

Dutch Trial Registration, NTR5932. https://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5932.

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Acknowledgements

The authors would like to thank Dr. H. H. J. M. Janssen for proofreading this article.

Funding

This research is funded by an “unrestricted grant” by the Amphia Fund for Innovation. Limited financial support has been provided by Vifor Pharma Nederland B.V. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands

    Ties L. Janssen, Chantal C. H. A. van Hoof-de Lepper, Jan H. Wijsman, Gwan H. Ho, Paul D. Gobardhan & Lijckle van der Laan

  2. Department of Public Health, Erasmus MC–University Medical Center Rotterdam, Rotterdam, The Netherlands

    Ewout W. Steyerberg

  3. Department of Gastroenterology, Amphia Hospital, Breda, The Netherlands

    Tom C. J. Seerden

  4. Department of Geriatrics, Amphia Hospital, Breda, The Netherlands

    Dominique C. de Lange

  5. Department of Cardiovascular Science, UZ Leuven, Leuven, Belgium

    Lijckle van der Laan

Authors
  1. Ties L. Janssen
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  2. Ewout W. Steyerberg
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  3. Chantal C. H. A. van Hoof-de Lepper
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  6. Jan H. Wijsman
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Contributions

All authors (TLJ, EWS, CCHAvHL, TCJS, DCL, JHW, GHH, PDG, LvdL) made a substantial contribution to the design and setup of this study, to collection and interpretation of data, and to the writing or revising of this manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ties L. Janssen.

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Conflict of interest

The PhD program of the corresponding author (T. L. Janssen) is funded by an ‘unrestricted grant’ by the Amphia Fund for Innovation. All other authors declare that they have no competing interests.

Ethics approval and consent to participate

The Medical Ethical Research Committee of Rotterdam, Maasstad Hospital (TWOR) approved the research protocol, ID number NL55694.101.15, in June 2016. Additionally, the Local Research and Development Committee at the Amphia Hospital approved the protocol (Local ID number 1473.16).

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Janssen, T.L., Steyerberg, E.W., van Hoof-de Lepper, C.C.H.A. et al. Long-term outcomes of major abdominal surgery and postoperative delirium after multimodal prehabilitation of older patients. Surg Today 50, 1461–1470 (2020). https://doi.org/10.1007/s00595-020-02044-0

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