Analysis of Frailty Syndrome Within the Framework of the Innovation Fund Project PRÄP-GO (ANA-PRÄP-GO)

Frequency of frailty is measured by modified Fried criteria (category 1 +2 = pre-frail, category 3 -5 = frail)

Frequency of neuro-cognitive disorder (mild / major NCD)

Incidence of delirium, defined according to Diagnostic and Statistical Manual of Mental Disorders (DSM-V), Richmond Agitation Scale (RASS), Nursing Delirium Screening Scale (Nu-DESC), Confusion Assessment Method (CAM), Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), along with the delirium severity scores Confusion Assessment Method Severity-Score (CAM-S) in English, Intensive Care Delirium Screening Checklist (ICDSC), Delirium Rating Scale Revised 98 (DRS-R-98) in English and patient chart review. The assessment period is from the recovery room up to five postoperative days or until hospital discharge.

Severity of delirium defined as a composite score based on: Confusion Assessment Method Severity-Score(CAM-S); Confusion Assessment Method (CAM), Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), Delirium Rating Scale Revised (DSR-R-98) in English, Intensive Care Delirium Screening Checklist (ICDSC) and Nursing Delirium Screening Scale (Nu-DESC) and patient chart review.

Nursing Delirium Screening Scale (Nu-DESC) score of ≥ 2 is indicative of delirium, range: 0-10 points, 10 = most severe.

Confusion Assessment Method (CAM) score is indicative of delirium, if the items 1 and 2 and 3 or the items 1 and 2 and 4 are measured positively.

Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score is indicative of delirium, if the items 1 and 2 and 3 or the items 1 and 2 and 4 are measured positively.

The Confusion Assessment Method Severity-Score (CAM-S Long Form) is an 10-item delirium screening instrument (range: 0-19 points, 19 = most severe).

The ICDSC is an 8-item delirium screening instrument (range: 0-8 points). The score is indicative of delirium, if the item is > 3.

The delirium rating scale revised 98 is a delirium screening instrument (range 0-46). The score is indicative of delirium, if the item is > 14.5.

A 7-point rating scale (0-7) was derived from the CAM-ICU and RASS assessments 0-2: no delirium, 3-5: mild to moderate delirium, and 6-7: severe delirium.

Delirium is identified chart-based.

The duration of delirium is measured in days.

SARS-CoV-2 infection

Cardiovascular function is measured by Transesophageal Echocardiography.

Cardiovascular function is measured by cardiovascular complications.

Wishes of the patient about the intensity of therapy and therapy goals are measured with a questionnaire.

Patient satisfaction score is measured with a likert scale (0 - 10)

Different tools and questionnaires are combined to measure Patient-related outcome.

Patient-reported experiences of health care are measured with a questionnaire.

incidence of dementia is measured by MOCA

incidence of cognitive impairment is measured by a validated score.

During memory consultation cognitive diagnostic findings are measured.

Stress is measured by Perceived Stress Questionnaire (PSQ20), which ranges from 20-80 points

Anxiety is measured by Generalized Anxiety Disorder 7, points range from 0-21

Anxiety 2 is measured by Faces Anxiety Scale, a valid single-item for self-report measure of state

Insomnia is measured by Insomnia Severity Index (ISI), which ranges from 0- 21 points

Routine neuroimaging results were planned to be documented in the hospital including all techniques to image the nervous system as ultrasound, magnetic resonance imaging, conventional radiography, computed tomography and positron emission tomography.

The need of treatment for curing an illness.

Adverse events are measured in all participants, who receive study measurements

Changes in the nutritional status after elective surgery

Adherence to Mediterranean diet (MD) is measured with a German Medi-Score, could range from 0 to 9, with higher scores (6-9) indicating greater MD adherence.

The composite outcome measure "Sarcopenia" is defined by the following three criteria: 1) low muscle strength (hand grip strength), 2) low muscle quantity (calf circumference and 3) low physical performance (gait speed). Criterion (1) identifies probable sarcopenia, additional documentation of criterion (2) confirms sarcopenia diagnosis, and if all criteria (1), (2) and (3) are met, sarcopenia is considered severe.

Calf circumference is measured in a standardized position and documented in centimeter.

Arm circumference is measured in a standardized position and documented in centimeter.

(number of teeth, Oral Health Assessment Tool (OHAT), Geriatric Oral Health Assessment Index (GO-HAI), questions regarding prothesis, dentist visits and dental care)

Quality of life is measured by Care Related Quality of Life (CarerQoL)

Complications are measured according to the Clavien-Dindo classification

Psychometric properties of the Meta Memory questionnaire are measured twice before surgery.

Routine laboratory results were planned to be documented in the hospital including hemoglobin, lymphocytes, total neutrophils, platelet count and white blood cell (WBC) count from blood samples.

Routine laboratory results were planned to be documented from the general practitioner including hemoglobin, lymphocytes, total neutrophils, platelet count and white blood cell (WBC) count from blood samples.

APOE polymorphisms are measured from whole blood once during hospital stay, an expected average of one week.

Total interleukin-8 is measured from whole blood

Acetylcholinesterase and Butyrylcholinesterase are measured from liquor

Acetylcholinesterase and Butyrylcholinesterase are measured from whole blood

Intracellular pH is measured from whole blood.

Autophagy of platelets is measured from whole blood.

Peripheral Blood Mononuclear Cell are measured from whole blood.

Multiplex gene expression analyzes (neuroinflammation and micro RNA panels) are measured from whole blood

Autoantibodies against beta2-adrenergic receptor, muscarinic acetylcholine receptor (M3 / M4), serotonin receptor, dopamine receptor are measured from serum

Trypotophan metabolites and short-chain fatty acids are measured from serum with metabolomic analysis

Biomarker are measured from serum by metabolomic analyses to characterize the frailty complex.

Cytokines (IFN-Ɣ IL-1β IL-4 IL-6 IL-10 IL-17A IL-17E IL-17F IL-21 IL-23 TGF-β1) are measured from plasma

Chemokines (CCL2 (MCP-1) CCL3 CCL4 CCL5 (RAN-TES) CCL11 (Eotaxin) CCL19 CCL20 CXCL1 CXCL8 (IL-8) CXCL10 (IP-10) CXCL12 (SDF1A) are measured from plasma

Markers immune-brain axis and gut-brain axis (zonulin, endothelial cell-specific molecule 1, S100A6, S100A8, S100A9, S100P, S100beta, Interleu-kin-16, CD162, BDNF, CD272, p-selectin, be-ta2microglobulin , Haptoglobin, cathelicidin, NCAM-1, BTLA and CXCR5) are measured from plasma

Proteins are measured from plasma by proteome analysis.

Analyzes of bacteria-specific 16S DNA from different biomaterial.

Analyzes of sequences of known microorganisms from different biomaterial.

Serum albumin is measured from whole blood

HbA1c is measured from whole blood

Vitamin D is measured from whole blood

Dementia markers: beta amyloid 1-40, beta-amyloid 1-42, beta-amyloid ratio (42/40 * 10), phospho-TAU, protein 14-3-3, PRPSc, TAU (total tau) are measured from liquor

Microbial diversity is measured from blood, urine and feces (e.g. Shannon index)

Relative frequency of metabolites is measured in urine

Secondary use of the biological samples in particular for research purposes

Hip Osteoarthritis Outcome is measured from Hip disability and Osteoarthritis Outcome Score (HOOS) in orthopedic patients from PG cohort

Knee Osteoarthritis Outcome is measured from Knee injury and Osteoarthritis Outcome (KOOS) in orthopedic patients from PG cohort

Temporal (e.g.: total activity duration, stance time) parameters are measured in orthopedic patients from PG cohort.

Kinetic parameters (e.g.: vertical plantar loading, loading symmetry) are measured in orthopedic patients from PG cohort.

Range of Motion of the hip/knee is measured during orthopedic investigation of PG cohort patients

Hip abduction force is measured during orthopedic investigation of PG cohort patients

Knee extension and flexion force measurement is measured during orthopedic investigation of PG cohort patients

Clinical investigation is measured by a neurosurgical method in patients from PG and NFC cohorts who undergo elective spine surgery and in control patients from NO cohort

ODI is measured in patients from PG and NFC cohorts who undergo elective spine surgery and in control patients from NO cohort.

Low Back pain is measured by the Roland Morris Low Back pain and disability questionnaire in patients (PG, NFC, NO cohorts) with lumbal spine problems.

Leg pain is measured by 100mm visual analog scale in patients (PG, NFC, NO cohorts) with lumbal spine problems.

To establish values for paresthesia, weakness and leg pain the Sciatica Bothersomeness Index is measured n patients (PG, NFC, NO cohorts) with lumbal spine problems.

To measure Disabilities of the Arm, Shoulder and Hand the DASH questionnaire is used in patient (PG, NFC, NO cohort) in patients with cervical spine problems

The modified Japanese Orthopaedic Association scale is used to establish criteria for mild, moderate and severe impairment in patients with degenerative cervical myelopathy in patients (PG, NFC, NO cohorts) with cervical spine problems

ASIA Impairment Scale is used to measure for patients with spinal myelopathies or spinal cord injuries in patients from PG and NFC cohorts who undergo elective spine surgery and in control patients from NO cohort

Multiprofessional skill management is evaluated in all participating occupations of the GB cohort in qualitative interviews.

Acceptance of participatory decision-making before and after participating in an SDM conference.

Depth of anesthesia is measured by brainwaves in different patient states which range from awake, sedated, unresponsive, surgically anesthetized to deeply anesthetized.

Electroencephalography spectral analysis is measured by brainwaves preoperatively.

Electroencephalography band power is measured postoperatively by an electroencephalography monitor at postoperative day 3 in all patients and in patients with delirium until 48 hours without positive delirium screening

Pain is evaluated with the Dolosys Paintracker. The Paintracker is a handy monitoring device to determine the analgesia needed for patients based on the pain reflex technique.