Pre-surgical Protocol for Frail Elderly People in Order to Reduce Hospitalization Days (APOPM).
Condition: Surgery; Old Age; Debility; Frail Elderly Syndrome; Post-Operative Confusion; Older Adults; Perioperative Care; Urologic Diseases; Digestive Disease; Anesthesia; Nurse-Patient Relations
MeSH terms: Digestive System Diseases; Gastrointestinal Diseases; Confusion; Urologic Diseases; Frailty
Study type: Interventional

Summary: 
      Elderly people (EP) have increased, as well as life expectancy at birth. In Chile there are
      more than 2 million 800 thousand EP, which corresponds to 1/6 of the Chilean population.

      The EP have a higher disease burden and mortality when facing surgery and in the
      postoperative period.

      Thus, this population frequently has longer hospital stays due to its degree of fragility,
      surgical complications or decompensation of its underlying pathologies, directly affecting
      health care systems.

      An inadequate preparation of the EP prior to surgery determined that the requirements of
      in-hospital as well as out-of-hospital care are extended, with the consequent which entails a
      higher cost in health.

      Current research underestimates the conditions of frailty and dependence in the EP. In
      addition, it is not routinely evaluated prior to surgery, as well as nutritional, metabolic,
      cognitive status and / or delirium screening is performed.

      There are accelerated recovery programs, which relate their interventions to specific
      pathologies; however, the age of the person is not taken into account.

      Surgical pre-habilitation interventions in the EP usually focus their efforts on physical and
      cardiovascular aspects, not including an integrative pre-surgical evaluation.

      Based on the foregoing, a prospective, interventional, longitudinal and randomized study has
      been proposed in a population of the EP who will undergo elective urology and coloproctology
      surgeries in two university hospitals (private and public).

      The objective of this study is to evaluate how the implementation of a timely pre-surgical
      conditioning (APO) protocol for frail elderly people reduces the days of hospital stay.

      The APO considers the most relevant aspects of physical and cardiovascular pre-habilitation,
      in addition to contemplating evaluations of frailty, dependence, cognitive status, screening
      for delirium, nutritional and metabolic.
    

Detailed description: 
      A prospective, interventional, longitudinal and randomized study has been proposed in a
      population of the EP who will undergo elective urology and coloproctology surgeries in two
      university hospitals: Red de Salud UC-Christus and Hospital Clinico La Florida. Both based on
      Santiago de Chile.

      The objective of this study is to evaluate how the implementation of a timely pre-surgical
      conditioning (APO) protocol for frail elderly people reduces the days of hospital stay.

      PM will be screened according to: co-morbidities, degree of frailty and dependence. This
      procedure will be carried out by a trained register nurse (RN) from the team at each center,
      who through a random system will enter 50% of the patients to the APO protocol (intervention)
      and the other 50% to the standard protocol of each institution. After that the RN will
      measure nutritional and cognitive status, drugs and alcohol consume and will take the
      protocol blood samples in the first evaluation two to three days after receiving an order for
      surgery for the physician.

      The APO considers the evaluations for a geriatric team, physical therapist team and
      nutritionist team in order to find out the most relevant aspects of physical, cardiovascular
      geriatric syndromes, cognitive status, nutritional and metabolic status.

      physical therapist team and nutritionist team they will prepare to the EP to surgery with
      physical, cardiovascular and dietary protocols adjusted to the patient, for the time of 4 to
      5 weeks before surgery.

      Upon admission of hospitalization for surgery, the RN in each of the two hospitals will
      evaluate the state of frail and dependence, nutritional and cognitive status, drugs and
      alcohol consume and delirium status in which the patients of both groups arrive.

      The analgesia and anesthesia of all patients in both groups, control and intervention, will
      be standardized to reduce confounding associated with intra- and postoperative anesthesia and
      analgesia.

      The registered nurse will follow the patient throughout the in-hospital process and via
      telemedicine or face-to-face will interview patients one month, second month and third month
      after discharge in search of possible problems associated with the peri-operative process.
    

Intervention name(s): Timely pre-surgical conditioning
Intervention type(s): Other
Intervention description(s): Timely pre-surgical conditioning seeks to prepare frail, pre-frail and / or dependent older patients for the surgery process. For which a work plan has been designed according to your needs and health conditions.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: randomized controlled, longitudinal.
Masking: Double (Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Older adults; Perioperative Care; Frail Elderly Syndrome; Pre-habilitation; length of stay in hospital