Multicomponent Prehabilitation as a Novel Strategy for Preventing Delirium in Older Chronic Limb Threatening Ischemia Patients: A Study Protocol

• Published in: Clinical interventions in aging Vol. 17; pp. 767 - 776
• Main Authors: Meulenbroek, Anne L, Faes, Miriam C, van Mil, Stefanie R, Buimer, M G, de Groot, Hans G W, Veen, Eelco J, Ho, Gwan H, Boonman-de Winter, Leandra J M, de Vries, Jolanda, van Gorkom, Rebecca, Toonders, Fleur, van Alphen, Rene, van Overveld, Karolien, Verbogt, Nathalie, Steyerberg, Ewout W, van der Laan, Lijckle
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 31-05-2022; Dove; Dove Medical Press
• Subjects: Aged; Aged patients; Amputation; Care and treatment; chronic limb threatening ischemia; vascular surgical procedures; delirium; Chronic Limb-Threatening Ischemia; Complications and side effects; Delirium; Delirium - epidemiology; Delirium - prevention & control; delirium/prevention and control; prehabilitation; Diagnosis; Humans; Ischemia - surgery; Limb Salvage; Medical care; Medical screening; Methods; Observational Studies as Topic; Peripheral Arterial Disease - surgery; Preoperative Exercise; Prospective Studies; Quality management; Quality of Life; Retrospective Studies; Risk Factors; Study Protocol; Treatment Outcome; Netherlands; prehabilitation; chronic limb threatening ischemia; vascular surgical procedures; delirium; delirium/prevention and control
• ISSN: 1178-1998; 1176-9092; 1178-1998
• DOI: 10.2147/CIA.S357812

Chronic limb threatening ischemia is the final stage of peripheral arterial disease. Current treatment is based on revascularization to preserve the leg. In the older, hospitalized chronic limb threatening ischemia patient, delirium is a frequent and severe complication after revascularization. Delirium leads to an increased length of hospital stay, a higher mortality rate and a decrease in quality of life. Currently, no specific guidelines to prevent delirium in chronic limb threatening ischemia patients exist. We aim to evaluate the effect of a multicomponent, multidisciplinary prehabilitation program on the incidence of delirium in chronic limb threatening ischemia patients ≥65 years.
A prospective observational cohort study to investigate the effects of the program on the incidence of delirium will be performed in a large teaching hospital in the Netherlands. This manuscript describes the design of the study and the content of this specific prehabilitation program.
Chronic limb threatening ischemia patients ≥65 years that require revascularization will participate in the program. This program focuses on optimizing the patient's overall health and includes delirium risk assessment, nutritional optimization, home-based physical therapy, iron infusion in case of anaemia and a comprehensive geriatric assessment in case of frailty. The primary outcome is the incidence of delirium. Secondary outcomes include quality of life, amputation-free survival, length of hospital stay and mortality. Exclusion criteria are the requirement of acute treatment or patients who are mentally incompetent to understand the procedures of the study or to complete questionnaires. A historical cohort from the same hospital is used as a control group.
This study will clarify the effect of a prehabilitation program on delirium incidence in chronic limb threatening ischemia patients. New insights will be obtained on optimizing a patient's preoperative mental and physical condition to prevent postoperative complications, including delirium.
This protocol is registered at the Netherlands National Trial Register (NTR) number: NL9380.