Recovery After Medical or Surgical Treatment

Study Overview
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Brief Summary
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This study aims to investigate the in-hospital care as well as the cognitive status, quality of life, physical function and risk of anxiety and depression, sleep disorders and drug use in a Danish cohort of both medical and surgical patients with acute critical illness without admittance to ICU (Intensive Care Unit) treatment, at three and twelve months after hospital discharge.

Detailed Description
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A stay at the ICU (intensive Care Unit) is related to life-threatening conditions and often displays a major impact on both physical and mental resources of the patients. Studies show that a great part of ICU patients have impairments of both physical and psychological kinds, some long-lasting. This condition is termed the post intensive care syndrome (PICS) and describes a wide range of symptoms as fatigue, depression, anxiety, memory loss along with both cognitive and physical impairments. Rehabilitative efforts are, thus, needed, and it has been suggested that ideally, rehabilitation should begin at the time of admission to the hospital and continue for a long time, possibly years, after the patient has been discharged. Regarding long term cognitive function of the ICU survivors in particular, recent studies have demonstrated severe impairment at the level of light Alzheimer's disease. In all of these studies, the reference group is the normal population, and it is a general problem that the cognitive and physical function of ICU patients before critical illness is unknown. There has recently been a norwegian study that included a reference group of surgical patients undergoing major surgery. The surgical group was older and more severely ill than the ICU group and was found to have a much worse cognitive function. Moreover, the cognitive function of the critically ill patients was not very far from the normal reference population due to selection. To determine to which degree the impairments can be attributed to ICU-admission, the investigators need to look at a hospitalised and representative, non-ICU population, which is what will be done in the study. The investigators will therefore include patients that have been admitted to surgical or medical department acute without admittance to the ICU and contact these patients 3 and 12 months after admission. Where there will be performed different tests in order to evaluate the the cognitive status, quality of life, physical function and risk of anxiety and depression, sleep disorders and drug use.

Official Title
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Recovery After Medical or Surgical Treatment - A Prospective Cohort Study

Conditions
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Cognitive Deficit

Intervention / Treatment
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* Other: there will be offered a follow up visit


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients > 18 years of age Admitted to surgical or medical department > 3 days Admitted with one of the following diagnoses: Pneumonia Heart failure Pulmonary embolism Acute myocardial infarction Pyelonephritis Patients undergoing non-elective open or laparoscopic abdominal surgery (not including elective procedures, diseases of the appendix, diseases of the gallbladder, liver, spleen, kidney, pancreas and emergency hernia surgery without bowel resection) Exclusion Criteria: Permanently incompetent patients not able to consent Not able to speak and understand Danish Discharged from the hospital for terminal care Patients transferred to another hospital during the stay Patients living outside the Region of Zealand Patients admitted under duress or actively psychotic Patients that are blind or severely visually impaired.

Ages Eligible for Study
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Minimum Age: 18 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

| Intervention/Treatment |
| --- |
|Other: there will be offered a follow up visit|The investigators will offer the patients a follow up visit 3 and 12 months after discharge from the hospital.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cognitive function | Cognitive Function measured by The Repeatable Battery for The Assesment of Neuropsychological Status (RBANS) | 3 months after discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cognitive function after one year | Cognitive function measured with The Repeatable Battery for the Assessments of Neuropsychological Status (RBANS) evaluation at 12 months after discharge from hospital | 12 months after discharge | 
| Rehabilitation after 3 months | This will be investigated by filling out a checklist of community support and contact to health care system at 3 month follow up | 3 months after discharge | 
| Self-reported health related quality of life | This will be investigated by filling out a questionnaire named SF 36, Short Form Health Survey. | 3 months after discharge | 
| Self-reported health related quality of life | This will be investigated by filling out a questionnaire named SF 36, Short Form Health Survey. | 12 months after discharge | 
| Objective assessment of physical function | This will be investigated by filling out a checklist called CPAx, The Chelsea Critical Care Physical Assessment Tool. | 3 months after discharge | 
| Objective assessment of physical function | This will be investigated by filling out a checklist called CPAx, The Chelsea Critical Care Physical Assessment Tool | 12 months after discharge | 
| Mortality | The mortality of the patients within 90 days after hospital discharge. | 90 days after discharge | 
| Consumption of opioids | Percentage of patients with a daily consumption of opioids at hospital admission and 90 days after discharge | 90 days after discharge | 
| Consumption of statins days after discharge | Percentage of patients with a daily consumption of statins at hospital admission and at 90 days after discharge | 90 days after discharge | 
| Consumption of anti-depressants | Percentage of patients with a daily consumption of anti-depressants at hospital admission and at 90 days after discharge | 90 days after discharge | 
| Sleepiness | This will be investigated by filling out Epworth Sleepiness Scale | At inclusion | 
| Sleepiness | This will be investigated by filling out Epworth Sleepiness Scale | 3 months after discharge | 
| Sleepiness | This will be investigated by filling out Epworth Sleepiness Scale | 12 months after discharge | 
| Insomnia | This will be investigated by filling out Insomnia Severity Index | At inclusion | 
| Insomnia | This will be investigated by filling out Insomnia Severity Index | 3 months after discharge | 
| Insomnia | This will be investigated by filling out Insomnia Severity Index | 12 months after discharge | 
| Sleep Quality | This will be investigated by filling out Pittsburgh Sleep Quality Index | At inclusion | 
| Sleep Quality | This will be investigated by filling out Pittsburgh Sleep Quality Index | 3 months after discharge | 
| Sleep Quality | This will be investigated by filling out Pittsburgh Sleep Quality Index | 12 months after discharge | 
| Information processing speed | This will be investigated by filling out the Trail Making Test Part A | 3 months after discharge | 
| Information processing speed | This will be investigated by filling out the Trail Making Test Part A | 12 months after discharge | 
| Executive function | This will be investigated by filling out the Trail Making Test Part B | 3 months after discharge | 
| Executive function | This will be investigated by filling out the Trail Making Test Part B | 12 months after discharge | 
| Rehabilitation after 12 months | This will be investigated by filling out a checklist of Community support and contact to health care system at 3 month follow up | 12 months | 
| Consumption of sleep medication | Percentage of patients with a daily consumption of sleep medication at hospital admission and 90 days after discharge | At inclusion | 
| Consumption of sleep medication | Percentage of patients with a daily consumption of sleep medication at hospital admission and 90 days after discharge | 90 days after discharge | 
| Consumption of sleep medication | Percentage of patients with a daily consumption of sleep medication at hospital admission and 90 days after discharge | 12 months after discharge |