Table 1.
PLUTO workflow
| Baseline assessment | Surgery | Postoperative period | 3-month follow-up | 1-year follow-up | |||||||||
| Active surveillance | Reactive surveillance | ||||||||||||
| Preoperative assessment | Morning of surgery | POD1 | POD2 | POD3 | POD4 | POD5 | POD6 | POD7 | |||||
| Informed consent | X | ||||||||||||
| Preoperative visit* | X | ||||||||||||
| Questionnaires† | X | X | X | ||||||||||
| Postoperative visit‡ | X | X | X | X | X | X | X | ||||||
| Handgrip strength | X | X | X | X | X | X | X | X | |||||
| Spirometry§ | X | X | |||||||||||
| DeltaScan EEG | X | X | X | X | X | X | X | ||||||
| Delirium assessment | X | X | X | X | X | X | X | ||||||
| Pain†† | X | X | X | X | X | X | X | X | X | X | |||
| Blood samples | |||||||||||||
| EDTA plasma | X | X | X | X | X | X | X | X | X | X¶ | |||
| Citrate plasma | X | X | X | X | X | X | X | X | X | X¶ | |||
| Serum | X | X | X | X | X | X | X | X | X | X¶ | |||
| Microbiome samples | |||||||||||||
| Oral swabs | X | X | X | ||||||||||
| Faeces | X | X | X | X | |||||||||
| Radiology | As clinically indicated, available from the electronic health records | ||||||||||||
| Cultures | As clinically indicated, available from the electronic health records | ||||||||||||
| Standardised complication registration** | X | X | X | X | X | X | X | X | |||||
*Preoperative visit includes collecting the following baseline information: demographics, comorbidities, intoxications, medication use, revised cardiac risk index and measurement of the capillary refill time and signs of neuropathic pain.
†Questionnaires include the EQ-5D, HADS, Barthel index, I-ADL, WHODAS2.0–12, DN4 and CFQ on baseline and 1-year follow-up. At 1-year follow-up, the IES-R scale is added. At 3-month follow-up, the EQ-5D, WHODAS2.0–12 and DN4 are obtained.
‡Postoperative bedside visits include clinical assessment of the patient including a capillary refill time, collecting information on mobility, physiotherapy, incentive spirometry, early warning score and Numeric Rating Scale and all items of the DN4.
§Spirometry is performed once in the postoperative period, on day 7 or the day closest to discharge.
¶Blood samples will only be obtained after the intensive follow-up of 7 days in case of an infection occurring. Sample protocol will be restarted until end of antibiotic treatment or for a maximum of 7 days.
**Complications registered are infectious complications, postoperative pulmonary complications, major adverse cardiac events, acute kidney injury, delirium and/or acute encephalopathy and (neuropathic) pain. Postoperative complications are registered using standardised, predefined criteria and throughout the entire hospital admission by trained research staff.
††Pain measurements include a numeric rating scale and all items of the DN4 to screen for neuropathic pain.
ADL, activities of daily living; CFQ, Cognitive Failure Questionnaire; DN4, Douleur Neuropathique (questionnaire); EEG, electroencephalography; EQ-5D, EuroQoL-5 Dimensions; HADS, Hospital Anxiety and Depression Scale; I-ADL, Instrumental ADL; IES-R, Impact of Event Scale-Revised edition; PLUTO, perioperative longitudinal study of complications and long-term outcomes; POD, postoperative day; WHODAS, WHO Disability Assessment Schedule.