Hempenius 2013.

Study characteristics
Methods	Design: multi‐centre, RCT Date of study: June 2007‐June 2010 Power calculation: yes but study underpowered Inclusion criteria: over 65 yrs; due to undergo elective surgery for a solid tumour, deemed to be frail (using Groningen Frailty Indicator >3) Exclusion criteria: unable to complete protocol; unable to complete follow‐up; unable to complete questionnaire
Participants	Sample size: 297 Country: the Netherlands Setting: 3 hospitals (1 university medical centre, 1 teaching hospital and 1 community hospital) Age: Mean age 77.45 (SD 6.72) in intervention group; 77.63 (SD 7.69) in usual care group Sex: 62.2% of intervention group were female compared with 65.8%of usual care group Co‐morbidity: stratified into < or equal to 2 co‐morbidities (39.6% of intervention group 40.4% of usual care group) or >2 co‐morbidities (60.4% in intervention group 59.6% of usual care group) Dementia: MMSE performed at baseline; mean score 26.6 in intervention group versus 26. 33 in usual care group (P = 0.49) Frailty: not reported
Interventions	Intervention: multi‐component intervention focused on best supportive care and the prevention of delirium. Preoperative geriatric team assessment with daily monitoring during hospital stay, supported by the use of standardised checklists Control: only had access to geriatric care if treating physician requested referral
Outcomes	Outcomes reported: ‐ Incident delirium, using DOSS ‐ if > 3 then had specialist assessment using DSM‐IV. ‐ Delirium severity, using DRS‐R‐98 ‐ Length of admission ‐ Mortality ‐ Return to independent living ‐ Postoperative complications ‐ Quality of life using Short‐Form‐36 ‐ Falls ‐ ADL using validated instrument using the Care Dependency Scale (CDS) ‐ Withdrawals Outcomes not reported: none Frequency of outcomes assessment: days 1‐10 postoperatively, 3 times per day
Notes	Funding source: Netherlands Organisation for Health Research and Development Declarations of interest: quote: “The authors declared that no competing interests exist” Delirium not excluded at enrolment No record of how many in usual care group received geriatrician input
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Interactive voice response telephone system for randomisation provided by university
Allocation concealment (selection bias)	Low risk	Central allocation system
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and research nurses unblinded
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Delirium assessment blinded to allocation
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	297 participants randomised, outcome assessments available for 260 (n = 127 in intervention group and n = 133 in control group) ‐ no information provided, described as ’lost to follow‐up’
Selective reporting (reporting bias)	Low risk	Outcomes reported as per original protocol
Other bias	Low risk	No evidence of other bias