Evidence map›Paper›PMID 39917250›Full record

ArticleEuropean journal of anaesthesiology and intensive care2024

Feasibility and effectiveness of an evidence-based intervention bundle to improve peri-operative care of older adults: A quality improvement study.

Cynthia Olotu, Lisa Lebherz, Anna Mende, Cordelia Hempel, Rebecca Philipp, Jennifer Schroeter, Lili Plümer, Birgit Koch, Martin Härter, Christian Zöllner and 2 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in European journal of anaesthesiology and intensive care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03325413 (Improvement of Perioperative Care of Elderly Patients), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03325413 nacompletednot on this map

Improvement of Perioperative Care of Elderly Patients

TypeinterventionalSponsorUniversitätsklinikum Hamburg-EppendorfRan2017 to 2020Enrolled310ConditionsPerioperative CareArmsSystematic inclusion of family members, Preoperative information, Physical and breathing exercises, Dietary supplements, Evaluation of long-term medication
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Trial
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Cynthia OlotuFrom the Department of Anaesthesiology (CO, AM, JS, LP, BK, CZ, RK), Department of Medical Psychology, University Medical Center Hamburg (LL, RP, MH, LK), Department of Anaesthesiology and Intensive Care, Rotkreuz-Hospital, Munich, Germany (RK) and St George Hospital, Intensive Care Unit, Kogarah, NSW Australia (CH).
Lisa LebherzFrom the Department of Anaesthesiology (CO, AM, JS, LP, BK, CZ, RK), Department of Medical Psychology, University Medical Center Hamburg (LL, RP, MH, LK), Department of Anaesthesiology and Intensive Care, Rotkreuz-Hospital, Munich, Germany (RK) and St George Hospital, Intensive Care Unit, Kogarah, NSW Australia (CH).
Anna MendeFrom the Department of Anaesthesiology (CO, AM, JS, LP, BK, CZ, RK), Department of Medical Psychology, University Medical Center Hamburg (LL, RP, MH, LK), Department of Anaesthesiology and Intensive Care, Rotkreuz-Hospital, Munich, Germany (RK) and St George Hospital, Intensive Care Unit, Kogarah, NSW Australia (CH).
Cordelia HempelFrom the Department of Anaesthesiology (CO, AM, JS, LP, BK, CZ, RK), Department of Medical Psychology, University Medical Center Hamburg (LL, RP, MH, LK), Department of Anaesthesiology and Intensive Care, Rotkreuz-Hospital, Munich, Germany (RK) and St George Hospital, Intensive Care Unit, Kogarah, NSW Australia (CH).
Rebecca PhilippFrom the Department of Anaesthesiology (CO, AM, JS, LP, BK, CZ, RK), Department of Medical Psychology, University Medical Center Hamburg (LL, RP, MH, LK), Department of Anaesthesiology and Intensive Care, Rotkreuz-Hospital, Munich, Germany (RK) and St George Hospital, Intensive Care Unit, Kogarah, NSW Australia (CH).
Jennifer SchroeterFrom the Department of Anaesthesiology (CO, AM, JS, LP, BK, CZ, RK), Department of Medical Psychology, University Medical Center Hamburg (LL, RP, MH, LK), Department of Anaesthesiology and Intensive Care, Rotkreuz-Hospital, Munich, Germany (RK) and St George Hospital, Intensive Care Unit, Kogarah, NSW Australia (CH).
Lili PlümerFrom the Department of Anaesthesiology (CO, AM, JS, LP, BK, CZ, RK), Department of Medical Psychology, University Medical Center Hamburg (LL, RP, MH, LK), Department of Anaesthesiology and Intensive Care, Rotkreuz-Hospital, Munich, Germany (RK) and St George Hospital, Intensive Care Unit, Kogarah, NSW Australia (CH).
Birgit KochFrom the Department of Anaesthesiology (CO, AM, JS, LP, BK, CZ, RK), Department of Medical Psychology, University Medical Center Hamburg (LL, RP, MH, LK), Department of Anaesthesiology and Intensive Care, Rotkreuz-Hospital, Munich, Germany (RK) and St George Hospital, Intensive Care Unit, Kogarah, NSW Australia (CH).
Martin HärterFrom the Department of Anaesthesiology (CO, AM, JS, LP, BK, CZ, RK), Department of Medical Psychology, University Medical Center Hamburg (LL, RP, MH, LK), Department of Anaesthesiology and Intensive Care, Rotkreuz-Hospital, Munich, Germany (RK) and St George Hospital, Intensive Care Unit, Kogarah, NSW Australia (CH).
Christian ZöllnerFrom the Department of Anaesthesiology (CO, AM, JS, LP, BK, CZ, RK), Department of Medical Psychology, University Medical Center Hamburg (LL, RP, MH, LK), Department of Anaesthesiology and Intensive Care, Rotkreuz-Hospital, Munich, Germany (RK) and St George Hospital, Intensive Care Unit, Kogarah, NSW Australia (CH).
Levente KristonFrom the Department of Anaesthesiology (CO, AM, JS, LP, BK, CZ, RK), Department of Medical Psychology, University Medical Center Hamburg (LL, RP, MH, LK), Department of Anaesthesiology and Intensive Care, Rotkreuz-Hospital, Munich, Germany (RK) and St George Hospital, Intensive Care Unit, Kogarah, NSW Australia (CH).
Rainer KiefmannFrom the Department of Anaesthesiology (CO, AM, JS, LP, BK, CZ, RK), Department of Medical Psychology, University Medical Center Hamburg (LL, RP, MH, LK), Department of Anaesthesiology and Intensive Care, Rotkreuz-Hospital, Munich, Germany (RK) and St George Hospital, Intensive Care Unit, Kogarah, NSW Australia (CH).

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMaintaining functional status is an essential therapeutic goal in peri-operative care of older adults. Although several recommendations concerning peri-operative management are available, pragmatic approaches to their sustainable implementation are lacking.

objectiveMultiple evidence-based recommendations for peri-operative care of older adults were bundled into a multicomponent intervention and assessed for feasibility and effectiveness.

designA quality improvement study with before-after comparison using a hybrid implementation-effectiveness approach.

settingUniversity Medical Centre. The trial was conducted from 2017 to 2020, follow-up was 1 week, 1 month and 6 months after surgery. PATIENTS: Patients at least 65 years old were scheduled for surgery; excluded: intercranial, ophthalmological, and emergency surgery; planned postoperative stay in the intensive care unit. A total of 720 patients were eligible; 278 patients were recruited, 95 (34) of whom were female.

interventionsThe intervention consisted of a set of recommended measures for peri-operative management of older patients, including pre-operative assessment and measures to manage frailty, malnutrition, polypharmacy, cognitive impairment and delirium. Patients were sequentially assigned to three groups: control (no change from usual care), transition (to implementation of the intervention) and intervention (fully implemented).

main outcome measuresFeasibility was assessed by determining the level of implementation, and barriers were identified by conducting qualitative interviews with the medical staff. Intervention effectiveness was estimated by Instrumental Activities of Daily Living (IADL; Lawton and Brody, primary clinical outcome) 1 and six months postoperatively. The secondary outcomes included postoperative complications, cognitive performance, quality of life and length of hospital stay.

resultsThe implementation rate was 77%. Pre-operative IADL was 9.9/10 (range 8 to 10; SD 0.4) and 9.7/10 (6 to 10, 0.8) for the control and intervention groups, respectively. There was no statistically significant difference between the groups in IADL (0.07, 95% CI -0.23 to 0.36,

conclusionThe implementation of evidence-based interventions to improve peri-operative care of older patients showed good feasibility in clinical routine but did not improve patients' functional status, which was already at a high level pre-operatively.

trial registrationClinicalTrials.gov, Identifier: NCT03325413.

Identifiers

PMID39917250
PMCPMC11798390

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.