The preliminary effect of a nursing intervention (the PREDOCS programme) to prepare frail older patients for cardiac surgery.

Abstract

Background: The patient population undergoing cardiac surgery has become older, sicker and of higher-risk. This results in an increase of postoperative delirium, depression, pressure ulcers and infections. A multicomponent, preadmission nursing intervention PREvention Decline in Older Cardiac Surgery patients (PREDOCS) was developed to better prepare frail older patients for elective cardiac surgery and to prevent postoperative complications. Aim: The aim of this study is to examine the preliminary effect of the PREDOCS-programme by older patients (≥65 years) who undergo cardiac surgery in a cardiac surgery centre in The Netherlands. Methods: This post-test only quasi experimental design is part of a larger multi-centre stepped wedge study in which three centres are involved. Study participants were 250 patients (≥65 years) who undergo cardiac surgery. 125 patients received usual care and 125 received the PREDOCS-programme. We compared the combined incidence of postoperative delirium, depression, pressure ulcer and/or infection in older cardiac surgery patients received the PREDOCS-programme with patients received usual care only in a cardiac surgery centre, by using logistic regression analyses. Results: Our final sample comprised 250 patients who underwent elective cardiac surgery with a median age of 73,45 years (first to third quartile: 68,6 – 78,8 years), predominantly male (77,6%), submitted to the following surgeries: CABG (45,2%), valve (20,8%), combined (10,8%), other (23,2%). Based on multiple analysis, a statistically significant association between care receiver and postoperative complications was found (ρ-value = 0,019). No significant association (ρ-value = 0,686) was found between the intervention and the combined incidence of postoperative complications. Conclusions: The PREDOCS-programme did not result in a clinically significant improvement in the prevention of postoperative complications. The results of the full trial should be awaited.