HCR.20.040 – Prehabilitation for multimorbid elderly patients undergoing surgery to improve patient-reported outcomes; the PROMES study

Route: Health care research, sickness prevention and treatment

Cluster question: 092 Can we combine mainstream and complementary therapies, leading to integrative health care that allows for the many differences between patients?

For multimorbid patients, surgery is a life-changing event that may result in physical deterioration, loss of independence and cognitive decline. To combat this, prehabilitation of elective surgical patients has successfully been studied and implemented in the Netherlands on a small scale in selected populations. However, not all complementary therapies have been studied or proven. Lower socioeconomic status and multimorbidity are independent risk factors for serious adverse postoperative outcomes, such as myocardial infarction, cerebrovascular events, renal failure and mortality. Most multimorbid elderly have modifiable riskfactors for these complications, including polypharmacy, frailty, impaired nutritional status, functional deficiencies, smoking or substance abuse. These risk factors provide a unique opportunity for prehabilitation before surgery to reduce risk and improve outcome. This is not only helpful perioperatively, but will ensure longterm and durable healthcare gains and QoL. We will use the surgery momentum to set these care pathways in motion. We aim to offer a new prehabilitation approach integrating existing therapies with complementary components to optimally prepare multimorbid patients for surgery. Our main objectives will be to develop and implement a new holistic, integrated and interdisciplinary person-centred prehabilitation best care pathway in multimorbid patients undergoing elective surgery, that will last into the post-surgical period. Generate empirical evidence on the (cost-)effectiveness of the new prehabilitation care pathways using PROM, morbidity and mortality and long-term changes of lifestyle. Design and evaluate implementation strategies for wider implementation of new prehabilitation care pathways in collaboration with relevant stakeholders. The outcome will be a multidisciplinary and transsectoral validated framework for cost-effective and evidence based best practice, patient-centred prehabilitation care pathways immediately implementable in clinics across the Netherlands.

Keywords

multimorbidity, older adult patients, patient reported outcomes, Prehabilitation, surgery

Other organisations

Multi-disciplinary and multi-sectorial national consortium including the Erasmus University Rotterdam and patient federations

Submitter

Organisation Amsterdam UMC - Location AMC
Name Dr. J. (Jeroen) Hermanides
E-mail j.hermanides@amsterdamumc.nl