Elder-friendly Approaches to the Surgical Environment (EASE) Study

Study Overview
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Brief Summary
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The aim of this study is to examine the impact implementing an elder-friendly surgical unit has on post-operative complications, mortality and quality of life for patients ≥ 65 years old who have undergone emergency surgical care.

Detailed Description
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The investigators hypothesize that the elder-friendly surgical unit will reduce in-hospital complications and mortality in a cost-effective manner, for this at risk population. Specific elder-friendly interventions include: Locate all elderly surgical patients on one nursing unit Interdisciplinary team-based care Elder-friendly evidence-informed practices including: comfort rounds with early mobilization, delirium prevention/management, optimal nutrition and prevention of post-operative complications Early and interdisciplinary discharge management This is a prospective, before-after study with a concurrent control group. Four senior patient groups will be followed:

Official Title
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Elder-friendly Approaches to the Surgical Environment - Implementation of an Elder Friendly Surgical Unit

Conditions
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General Surgery

Intervention / Treatment
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* Other: Elder-Friendly Surgical Unit


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients > 65 years old admitted for Acute care and Emergency Surgery Received acute abdominal surgery Exclusion Criteria: Elective general surgery cases Nursing home resident requiring full nursing care [dependency in 3 or more activities of daily living ] Palliative surgery [surgery with the primary intention of improving quality of life or relieving symptoms caused by advancing non-curative disease] Multi-system trauma Patients from out of province or transferred from another inpatient service or hospital

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pre-Elder Friendly Surgical Intervention Group<br>Elder Acute Care and Emergency Surgery patients | |
| Post-Elder Friendly Surgical Intervention Group<br>Elder Acute Care and Emergency Surgery patients | Other: Elder-Friendly Surgical Unit<br> <br> |
| Pre-Elder Friendly Surgical Control Group<br>Elder Acute Care and Emergency Surgery patients | |
| Post-Elder Friendly Surgical Control Group<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post-Operative complications | Includes a) intensive care unit admission (includes respiratory failure, cardiac arrest or septic shock), b) vascular complications (myocardial infarction, stroke, deep venous thrombosis, pulmonary embolism), c) serious infections (pneumonia, intra-abdominal abscess, urinary tract infection, deep wound infection or infected decubitus ulcer) or d) protracted delirium (≥48 hours) | During initial in-hospital stay (0-12 weeks on average) | 
| Death |  | During initial in-hospital stay (0-12 weeks on average) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post-discharge complications or health-events requiring re-admission |  | Within 30 days post-discharge | 
| Cost per quality-adjusted life year | Both direct and indirect study participant costs | 6 months post-discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Senior, Elderly, Acute Care, Emergency Surgery