Preoperative multidisciplinary team decisions for high-risk patients scheduled for noncardiac surgery—a retrospective observational study

Vernooij, Jacqueline E. M.; Smulders, Pascal S. H.; Geurts, José W.; Kalkman, Cor J.; Koning, Nick J.

doi:10.1007/s12630-021-02114-y

Cited by 3 publications

(6 citation statements)

References 24 publications

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“…However, the results of our cohort were comparable to those reported in the limited published literature. Vernooij et al described in a retrospective cohort study that preoperative MDT meetings for noncardiac surgery led to a high rate of alterations to the initial surgical and anesthesia management plans, including a high percentage (43%) of decisions to convert the initially planned surgery to nonsurgical management [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Does preoperative multidisciplinary team assessment of high-risk patients improve the safety and outcomes of patients undergoing surgery?

Kuiper,

Janssen,

Versteeg

et al. 2024

BMC Anesthesiol

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Background International guidelines recommend preoperative multidisciplinary team (MDT) assessment for high-risk surgical patients. Preoperative MDT meetings can help to improve surgical care, but there is little evidence on whether they improve patient outcomes. Methods This paper aims to share our experience of MDT meetings for high-risk surgical patients to underline their added value to the current standard of care. An observational study of a retrospective cohort of preoperative high-risk MDT meetings of a tertiary referral hospital between January 2015 and December 2020. For 249 patients the outcomes preoperative data, MDT decisions, and patient outcomes were collected from electronic health records. Main results A total of 249 patients were discussed at high-risk MDT meetings. Most of the patients (97%) were assessed as having an American Society of Anesthesiology score ≥ 3, and 219 (88%) had a European Society of Cardiology and European Society of Anaesthesiology risk score of intermediate or high. After MDT assessment, 154 (62%) were directly approved for surgery, and 39 (16%) were considered ineligible for surgery. The remaining 56 (23%) patients underwent additional assessments before reconsideration at a high-risk MDT meeting. The main reason for patients being discussed at the high-risk MDT meeting was to assess the risk-benefit ratio of surgery. Ultimately, 184 (74%) patients underwent surgery. Of the operated patients, 122 (66%) did not have a major complication in the postoperative period, and 149 patients (81%) were alive after one year. Conclusions This cohort study shows the vulnerability and complexity of high-risk patients but also shows that the use of an MDT assessment contributes too improved peri- and postoperative treatment strategies in high-risk patients. Most patients underwent surgery after careful risk assessment and, if deemed necessary, preoperative and perioperative treatment optimization to reduce their risk.

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Section: Discussionmentioning

confidence: 99%

Does preoperative multidisciplinary team assessment of high-risk patients improve the safety and outcomes of patients undergoing surgery?

Kuiper,

Janssen,

Versteeg

et al. 2024

BMC Anesthesiol

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“…The current trial employed a stepped-wedge design to address ethical concerns. This decision was based on the appreciation for existing MDT meetings among patients and physicians and the moral dilemma posed by denying patients the opportunity to have their cases discussed in preoperative MDT meetings in hospitals where such meetings are already standard practice [ 4 , 5 , 34 – 36 ]. Therefore, participating hospitals were selected based on the absence of established preoperative MDT meetings.…”

Section: Methodsmentioning

confidence: 99%

“…The results showed that this sample size would achieve 87% power with a two-sided test at a 5% significance level. These calculations were based on pilot data that showed a 43% adverse event rate in the control group and a 27.5% rate in the intervention group [ 5 ]. We used the Shiny CRT calculator: https://clusterrcts.shinyapps.io/rshinyapp to calculate the sample [ 38 ].…”

Section: Methodsmentioning

confidence: 99%

“…European and US guidelines on perioperative care recommend preoperative multidisciplinary discussion for high-risk noncardiac surgical patients [ 15 – 17 ]. However, the added value of preoperative MDT discussions is currently based on the consensus of expert opinion, registries, and small or retrospective studies [ 5 , 18 , 19 ]. A previous study where high-risk patients planned for noncardiac surgery were selected for preoperative MDT discussions by the anesthesiologist at the preoperative clinic, showed that 43% of high-risk patients did not undergo surgery after discussion in a preoperative MDT meeting [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, the added value of preoperative MDT discussions is currently based on the consensus of expert opinion, registries, and small or retrospective studies [ 5 , 18 , 19 ]. A previous study where high-risk patients planned for noncardiac surgery were selected for preoperative MDT discussions by the anesthesiologist at the preoperative clinic, showed that 43% of high-risk patients did not undergo surgery after discussion in a preoperative MDT meeting [ 5 ]. Cancelation of surgery was related to either the multidisciplinary team consensus-based advice or the patient’s own decision after reconsidering the surgical harm-benefit ratio.…”

Section: Introductionmentioning

confidence: 99%

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Is a preoperative multidisciplinary team meeting (cost)effective to improve outcome for high-risk adult patients undergoing noncardiac surgery: the PREPARATION study—a multicenter stepped-wedge cluster randomized trial

Vernooij,

Boerlage,

Doggen

et al. 2023

Trials

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Background As a result of increased life expectancy and improved care for patients suffering from chronic disease, the number of patients with multimorbidity requiring surgical intervention is increasing. For complex surgical patients, it is essential to balance the potential benefits of surgical treatment against the risk of permanent loss of functional capacity and quality of life due to complications. European and US guidelines on perioperative care recommend preoperative multidisciplinary team (MDT) discussions for high-risk noncardiac surgical patients. However, the evidence underlying benefits from preoperative MDT meetings with all relevant perioperative specialties present is limited. The current study aims to investigate the effect of implementation of preoperative MDT discussions for high-risk patients undergoing noncardiac surgery on serious adverse events. Methods/design PREPARATION is a stepped-wedge cluster randomized trial in 14 Dutch hospitals without currently established preoperative MDT meeting. The intervention, preoperative MDT meetings, will be implemented sequentially with seven blocks of 2 hospitals switching from control (preoperative screening as usual) to the intervention every 3 months. Each hospital will be randomized to one of seven blocks. We aim to include 1200 patients. The primary outcome is the incidence of serious adverse events at 6 months. Secondary outcomes include (cost)effectiveness, functional outcome, and quality of life for up to 12 months. Discussion PREPARATION is the first study to assess the effectiveness of a preoperative MDT meeting for high-risk noncardiac surgical patients in the presence of an anesthesiologist. If the results suggest that preoperative MDT discussions for high-risk patients are (cost)-effective, the current study facilitates implementation of preoperative MDT meetings in clinical practice. Trial registration ClinicalTrials.gov NCT05703230. Registered on 11/09/2022.

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The association between preoperative multidisciplinary team care and patient outcome in frail patients undergoing cardiac surgery

Smoor

Dongen

Daeter

et al. 2023

The Journal of Thoracic and Cardiovascular Surgery

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Preoperative multidisciplinary team decisions for high-risk patients scheduled for noncardiac surgery—a retrospective observational study

Cited by 3 publications

References 24 publications

Does preoperative multidisciplinary team assessment of high-risk patients improve the safety and outcomes of patients undergoing surgery?

Does preoperative multidisciplinary team assessment of high-risk patients improve the safety and outcomes of patients undergoing surgery?

Is a preoperative multidisciplinary team meeting (cost)effective to improve outcome for high-risk adult patients undergoing noncardiac surgery: the PREPARATION study—a multicenter stepped-wedge cluster randomized trial

The association between preoperative multidisciplinary team care and patient outcome in frail patients undergoing cardiac surgery

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