Objective: Delirium is a common and serious postoperative complication in elderly patients undergoing abdominal aortic aneurysm (AAA) repair and is associated with a variety of adverse outcomes. Multimodal prehabilitation aims to identify and minimize potential risk factors for delirium and improve overall health. The aim of this study is to investigate the effect of multimodal prehabilitation on delirium incidence in elderly patients undergoing elective repair for AAA.
Methods: A single-centre cohort analysis was performed in the Netherlands for patients aged ≥ 70 years, undergoing elective repair for AAA (open surgery and endovascular aortic repair). Prehabilitation was gradually introduced between 2016 and 2019 and offered as standard care from 2019. The program was constructed to optimize overall health and included delirium risk assessment, home-based tailor-made exercises by a physical therapist, nutritional optimization by a dietician, iron infusion in case of anaemia and a comprehensive geriatric assessment by a geriatrician in case of frailty. The primary outcome was incidence of delirium within 30 days after surgery.
Results: A total of 81 control and 123 prehabilitation patients were included. A reduction in incidence of delirium was found (11.1% in the control group to 4.9% in the prehabilitation group), with too small numbers to reach statistical significance (p=0.09). Also, patients in the prehabilitation group had a small, non-significant decreased length of hospital stay (4 days) compared to the control group (5 days) (p=0.07).
Conclusion: Although no significant differences were found, we carefully conclude that this study provides some support for implementing multimodal prehabilitation for delirium prevention in elderly patients undergoing AAA repair. Further research with larger cohorts is necessary to identify and select patients that would most benefit from prehabilitation.

Plain Language Summary: Delirium is a common complication in elderly patients after undergoing abdominal aortic aneurysm (AAA) repair. Delirium is associated with a prolonged hospital-stay, decreased quality of life and increased mortality. To prevent delirium it is important to identify possible risk factors and assess the patients’ overall fitness. This is best done preoperatively, since the patient is not yet recovering from a major surgery. This is called “prehabilitation”.
In this study, we investigated the effect of multimodal prehabilitation in patients undergoing surgery for an AAA. The program consists of:Individual delirium risk-assessment,Personalized home-based tailor-made exercises,Nutritional optimization,Iron infusion in case of anaemia, andA comprehensive geriatric assessment by a geriatrician in case of frailty.
Eighty-one control and 123 prehabilitation patients were included. A reduction in incidence of delirium was found (11.1% control to 4.9% prehabilitation), with too small numbers to reach statistical significance (p=0.09). Also, patients in the prehabilitation group had a small, non-significant decreased length of stay (4 days) compared to the control group (5 days) (p=0.07).
Prehabilitation may be effective in preventing delirium in elderly patients undergoing AAA repair. Further research is necessary to identify and select patients that would most benefit from prehabilitation.

Keywords: aneurysm of the abdominal aorta, prehabilitation, preoperative rehabilitation, delirium, delirium/prevention and control


中文翻译：

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预康复对于预防腹主动脉瘤择期手术中谵妄的潜在价值


目的：谵妄是接受腹主动脉瘤（AAA）修复的老年患者常见且严重的术后并发症，并与多种不良后果相关。多模式预康复旨在识别并最大程度地减少谵妄的潜在危险因素并改善整体健康状况。本研究的目的是探讨多模式预康复对接受 AAA 择期修复的老年患者谵妄发生率的影响。

方法：在荷兰对年龄≥ 70 岁、接受 AAA 择期修复（开放手术和血管内主动脉修复）的患者进行单中心队列分析。康复治疗在 2016 年至 2019 年间逐步推出，并从 2019 年起作为标准护理提供。该计划旨在优化整体健康，包括谵妄风险评估、物理治疗师的家庭定制锻炼、营养师的营养优化、铁剂输注如果出现贫血，则由老年科医生进行全面的老年评估以防止虚弱。主要结局是术后 30 天内谵妄的发生率。

结果：共纳入 81 名对照患者和 123 名康复患者。研究发现谵妄发生率有所降低（对照组为 11.1%，康复组为 4.9%），但数量太少，无法达到统计学显着性（p=0.09）。此外，与对照组（5 天）相比，预康复组患者的住院时间（4 天）有小幅但不显着的缩短（p=0.07）。

结论：虽然没有发现显着差异，但我们仔细得出结论，这项研究为接受 AAA 修复的老年患者实施多模式预康复以预防谵妄提供了一些支持。有必要对更大的队列进行进一步的研究，以确定和选择最能从预康复中受益的患者。


通俗语言总结：谵妄是老年患者接受腹主动脉瘤（AAA）修复术后的常见并发症。谵妄与住院时间延长、生活质量下降和死亡率增加有关。为了预防谵妄，重要的是确定可能的危险因素并评估患者的整体健康状况。这最好在术前完成，因为患者尚未从大手术中恢复。这称为“预康复”。

在这项研究中，我们调查了多模式预康复对接受 AAA 手术的患者的效果。该计划包括：个人谵妄风险评估、个性化家庭定制练习、营养优化、贫血情况下的铁剂输注以及老年病学家针对虚弱情况进行的全面老年评估。

包括 81 名对照患者和 123 名康复患者。结果发现谵妄的发生率有所降低（对照组为 11.1%，康复前为 4.9%），但数量太少，无法达到统计显着性（ p = 0.09）。此外，与对照组（5 天）相比，预康复组患者的住院时间（4 天）有小幅但不显着的缩短（ p = 0.07）。

预康复可能可以有效预防接受 AAA 修复的老年患者出现谵妄。需要进一步的研究来识别和选择最能从预康复中受益的患者。


关键词：腹主动脉瘤，预康复，术前康复，谵妄，谵妄/预防和控制