Disorientation, confusion, memory loss, and speech difficulties. Patients over sixty and about to undergo surgery could be at risk of developing any or all of these symptoms after surgery. Postoperative delirium (POD) is the most common postoperative complication occurring in 20% of surgical patients aged 60+. POD leads to adverse outcomes such as longer hospital stays, an increased risk of death within six months and doubles the risk of nursing home admission. POD costs health insurers 1-2 billion Euros in Germany alone each year, and over 30% of older patients who experienced POD will suffer from long-term cognitive decline and dementia.
There are no treatments for POD available once symptoms arise. Instead, the focus is on prevention. Nonpharmacological preventive interventions are highly effective but are too costly to be deployed for every patient. Our pre-operative risk prediction tool highlights patients at risk before undergoing surgery. This patient-centric approach increases patient value by improving health outcomes and decreasing costs over the full cycle of care.
Together with our academic partners, Cochrane Anaesthesia, Cochrane review, and Mac Master university, we have collected data from over 20,000 patients from over 20 clinical trials around the world. These data were used to develop and validate our POD risk prediction algorithm. This algorithm was integrated with a browser-based and platform-independent user interface: the PIPRA tool. It can be incorporated into all modern hospital record systems.
Throughout the developmental phase of our tool, we conducted interviews with patients, their relatives, and clinicians to get their perspectives on the problem and our solution. We adjusted it based on their responses. Our tool itself is “patient-centered, and doctor driven”.
Despite the severe adverse outcomes of POD, this risk is seldom mentioned to the patients before surgery, and this is recognised by international expert societies, such as the fifth international Perioperative Neurotoxicity Working Group (2018). Our tool will provide clinicians with an objective risk score to discuss with their patients, allowing a clearer communication of the risk and benefits of the surgical intervention. This will empower the patients and their families who will be able to give truly informed consent.
An explanatory in-depth budget impact analysis showed that we can save an average public hospital in Switzerland 2.2M CHF (2M Euro) annually by reducing the length of stay and improving patient outcomes. (Budget Impact Analysis attached)
We have completed two pilot projects in Switzerland and validated the usability of our software in the clinical setting. Our third project, which applies targeted prevention based on our initiative in the biggest private hospital in Switzerland, will be completed in the Summer of 2023 and will show the benefit of the tool.