A novel anesthesiologist‐led multidisciplinary model for evaluating high‐risk surgical patients at a comprehensive cancer center

Abstract

The objective of this retrospective analysis was to describe the development and implementation of an anesthesiologist-led multidisciplinary committee to evaluate high-risk surgical patients in order to improve surgical appropriateness. The study was conducted in an anesthesia preoperative evaluation clinic at an academic comprehensive cancer center. One hundred sixty-seven high-risk surgical patients with cancer-related diagnoses were evaluated and discussed at a High-Risk Committee (HRC) meeting to determine surgical appropriateness and optimize perioperative care. The HRC is an anesthesiologist-led model for multidisciplinary review of high-risk patients developed at Roswell Park Comprehensive Cancer Center. The group of high-risk patients in which surgery was not performed had, on average, a greater percentage of hypertension, smoking history, dyspnea, heart failure, chronic obstructive pulmonary disease, diabetes, renal failure, and sleep apnea than the group in whom surgery was performed. Only one of 107 high-risk patients who had surgery died within the first 30 days after surgery. A smaller percentage of patients died in the group that had surgery versus the group in which surgery was canceled. For all patients discussed by the HRC, the mortality was less than 2% within the first 30 days after the HRC.

The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

“…At our institution, the utility of decision making across multiple disciplines was quickly recognized, and High-Risk Conferences have been held since April 2010. Several reports on high-risk conferences have been published [12][13][14]; however, they appeared to focus more on process. We analyzed outcomes for numerous patients after High-Risk Conferences, particularly those for whom procedures were modified or cancelled.…”

“…We analyzed outcomes for numerous patients after High-Risk Conferences, particularly those for whom procedures were modified or cancelled. Sroka et al reported on the utility of high-risk conferences at a cancer center [14]. In that study, discussions of medical comorbidities were the main focus, and anesthesiologists usually took the initiative at the conferences.…”

Modern preoperative evaluation in ambulatory surgery – who, where and how?

“…Besides promoting patient-centered care it may further improve clinical outcome and reduce resource overuse [47,48]. As a multidisciplinary process, shared decisionmaking implies a discussion between the patient and their healthcare providers, including surgeons and anesthesiologists [49]. After carefully evaluating all medical and surgical treatment options including scientific evidence, advantages, disadvantages, prognosis, risks and benefits, an individualized care plan is customized for each patient according to his physical condition, goals, and expectations [48].…”

Addressing comorbidities in the perioperative setting and optimizing perioperative medicine education

“…Anesthesia providers as perioperative clinicians are in a unique position to coordinate interdisciplinary conversations that incorporate patient goal concordant care and realistic assessment of perioperative complications based on the patient's comorbidities [18,19]. As facilitators of these complex perioperative discussions, anesthesia providers must be equipped to assess a patient's decision-making capacity before embarking on advance care planning [20].…”