Perioperative Multimodal Care for Cystectomy Frail Patient
Frail Elderly Syndrome, Bladder Disease, Nutrition Disorders
About this trial
This is an interventional other trial for Frail Elderly Syndrome focused on measuring prehabilitation, nutrition, hydration, cystectomy and urinary diversion, regional anesthesia, cognition
Eligibility Criteria
Inclusion Criteria:
- Informed Consent as documented by signature (Appendix Informed Consent Form)
- ≥ 75 years old
- Fried frailty score ≥2
- Cystectomy with urinary diversion
- No contra-indication for spinal or epidural anesthesia
Exclusion Criteria:
- Contraindications to the class of drugs under study, e.g. known hypersensitivity or allergy to class of drugs or the investigational product,
- Women who are pregnant or breast feeding (not applicable as recruitment concerns patients with ≥75 yrs of age)
- Known or suspected non-compliance, drug or alcohol abuse,
- Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, dementia, etc. of the participant,
- Enrolment of the investigator, his/her family members, employees and other dependent persons,
- Specific exclusions for the disease under study,
- Specific concomitant therapy washout requirements prior to and/or during study participation,
- Dietary restrictions: milk allergy
- Refusal to regional anesthesia
- Risk of aspiration
- Oral fluid restriction due to any reasons (severe renal insufficiency i.e. GFR < 20ml/min)
Sites / Locations
- University Hospital Inselspital
Arms of the Study
Arm 1
Experimental
Intervention
Around 2 to 4 weeks before surgery: Fried frailty score CARE score assessment NRS Kondrup assessment Plasma albumin and CRP values Start with daily oral whey protein administration until evening before surgery45 Around 5-7 days before surgery: - Start with immunonutrition Evening before surgery: CARE score assessment NRS Kondrup CERAD cognition test assessment Plasma albumin and CRP values, urine specific gravity Carbohydrate loading If urine specific gravity is >1.020 then additional tap water drinking will be encouraged Day of surgery: Carbohydrate loading Start anesthesia with spinal anesthesia (continuous) POD 7: CARE assessment CERAD assessment Plasma albumin and CRP values POD14: CARE assessment Plasma albumin and CRP value POD 30: CARE assessment NRS Kondrup CERAD assessment Plasma albumin and CRP values POD 90: CARE assessment NRS Kondrup CERAD assessment