Effectiveness of the PREDOCS-programme: a pre-post test study. Effect of a nursing intervention ‘PREvention Decline in Older Cardiac Surgery patients’ (PREDOCS) programme for preventing postoperative complications in a hospital specialized in cardiac surgery

Abstract

Background: Postoperative complications such as infections, pressure ulcer, delirium and depression occur frequently in frail older patients after cardiac surgery. The intervention ‘PREvention Decline in Older Cardiac Surgery patients’ (PREDOCS-programme) is a complex nursing-intervention, to optimize patients aged ≥65 years indicated for cardiac surgery in the pre-admission period. Besides information about the operation, pain-management and good nutrition, patients at risk are detected using screening-scorecards. Also, tailored advices are provided, so that patients can work within their home-situation, reducing there increased risk for postoperative complications. Aim: To evaluate the effect of the PREDOCS-programme by comparing the incidence of the combined incidence of the four postoperative complications in an intervention and control-group. Method: A pre-post test design was carried out, as part of a still-running larger multicentre stepped wedge trial. The control-group exists out of patients who received usual care, the intervention-group received in addition the PREDOCS-programme. Results: Besides collected data of 50 patients, data was supplemented with 200 patients using multiple imputation. 64/125 in the intervention-group and 61/125 patients from the control-group developed a postoperative complication, mostly a risk for developing a depression. After correction in a multivariate analysis only a slight non-significant difference was found between the groups (OR 0.954, 95%-confidence interval 0.556-1.634). In the intervention-group less pressure ulcer, infections or risk for depression was found, but significantly more patients developed a (risk for) delirium. Furthermore, significantly more patients in the control-group died (p=0.02). Conclusion: These data showed no reduction of postoperative complications in older patients undergoing cardiac surgery when included in the PREDOCS-group. Recommendations: To measure the effect of a pre-admission intervention, preoperatively re-screening patient’s risk for postoperative complications could be beneficial when the patient is admitted to the hospital. Furthermore, to draw conclusions from the effectiveness of the pre-admission intervention PREDOCS-programme, results from the multicentre trial are needed.