The high-risk surgical patient: a role for a multi-disciplinary team approach?

Whiteman, A.R.; Dhesi, Jugdeep; Walker, D.

doi:10.1093/bja/aev355

Cited by 40 publications

(38 citation statements)

References 16 publications

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“…32 The preoperative anesthesia evaluation is an opportunity to further investigate these broader issues and intervene. 21 As we have seen, neither patient age, ASA PS class, nor comorbidity necessarily guarantees an HRC meeting. Important issues may evolve and reveal themselves between the surgical appointment and the day of surgery.…”

Section: Discussionmentioning

confidence: 82%

“…It is not always feasible for the surgical consultation to identify all aspects of the patient's complex history . The preoperative anesthesia evaluation is an opportunity to further investigate these broader issues and intervene . As we have seen, neither patient age, ASA PS class, nor comorbidity necessarily guarantees an HRC meeting.…”

Section: Discussionmentioning

confidence: 99%

“…The Royal College of Anesthetists has proposed a multidisciplinary approach to surgical care in the perioperative period. Meetings should be facilitated to make a collaborative decision as to whether or not to operate, to optimize the patient preoperatively, and to outline the multidisciplinary care needed intra‐ and postoperatively . Anesthesiologists, especially those involved in all facets of perioperative care, from preoperative evaluation through the surgery and postoperative critical care and pain management, are uniquely positioned to facilitate collaboration for appropriate surgical care in a multidisciplinary format.…”

Section: Introductionmentioning

confidence: 99%

“…Meetings should be facilitated to make a collaborative decision as to whether or not to operate, to optimize the patient preoperatively, and to outline the multidisciplinary care needed intra-and postoperatively. 21 Anesthesiologists, especially those involved in all facets of perioperative care, from preoperative evaluation through the surgery and postoperative critical care and pain management, are uniquely positioned to facilitate collaboration for appropriate surgical care in a multidisciplinary format. Anesthesiologists may be able to offer insight and expertise on how the patient's comorbidities may affect the surgical approach, outcomes, and quality of life after surgery.…”

mentioning

confidence: 99%

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

Sroka

Gabriel

Al-Hadidi

et al. 2018

J of Healthc Risk Manag

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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.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Sroka

Gabriel

Al-Hadidi

et al. 2018

J of Healthc Risk Manag

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“…This includes roles in improving care coordination, interdisciplinary communication, and patient safety [3–5]. Della Roca and colleagues [6**] discussed the role of the anesthesiologist on a MDT, specifically with regard to the preoperative evaluation of high-risk patients undergoing lung resection surgery.…”

Section: The Multidisciplinary Team Conceptmentioning

confidence: 99%

Organization of Multidisciplinary Cancer Care for the Surgical Patient: Role of Anesthesiologists

Rieth

Fischer

Afonso

2018

Curr Anesthesiol Rep

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Purpose of review: The purpose of this review is to describe significant recent trends or developments regarding the role of anesthesiologists in a multidisciplinary team approach to cancer care for the surgical patient. We also discuss our own institutional multidisciplinary approach as a comprehensive cancer center with high surgical volume. Recent findings: Beyond the multidisciplinary team meeting concept, and local, institution-specific, or national programs, more formalized concepts and models of perioperative care have evolved. These provide a framework for robust involvement of anesthesiologists in cancer care for the surgical patient, with the goal of allowing for optimal individualized cancer outcomes. Summary: Because of the wide-ranging nature of their perioperative expertise, anesthesiologists play an important role in multidisciplinary team cancer care for surgical patients. This role has been seen in the recent trends toward clinical models, such as the perioperative surgical home and enhanced recovery programs. Areas for future research include multidisciplinary assessment of the impact of such models on perioperative cancer outcomes through integration of data from national outcomes groups.

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Aortic arch surgery for type B aortic dissection: How far should we go? The value of a hybrid approach

Capoccia

Sherif

Nassef

et al. 2023

Clinical Case Reports

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Traditionally, the management of type B aortic dissection has been the domain of the vascular surgeons. Timing and type of intervention still generate debate. We sought to review our early experience with the treatment of this condition based on a hybrid approach following an aortic multi‐disciplinary team meeting involving close cooperation between cardiac surgeons, vascular surgeons, interventional radiologists, vascular anesthetists, and cardiac anesthetists. Four patients (age 41–56 years; 3 males; 1 female) with type B aortic dissection underwent aortic arch surgery through a hybrid approach: one elective procedure consisting of ascending aorta and hemi‐arch replacement with debranching followed by thoracic endovascular aortic repair (TEVAR); one redo procedure requiring aortic arch replacement with hybrid frozen elephant trunk; two acute presentations (aortic arch replacement and debranching followed by TEVAR; AVR with ascending aorta, arch, and proximal descending thoracic aorta replacement with conventional elephant trunk and debranching). Deep hypothermic circulatory arrest was required in three patients. Despite respiratory complications and slightly prolonged postoperative course, all patients survived without onset of stroke, paraplegia, malperfusion, endoleak, or need for re‐exploration. Follow‐up remains satisfactory. Different factors may affect outcome following complex aortic procedures. Nevertheless, close cooperation between cardiac surgeons, vascular surgeons, and interventional radiologists may reduce potential for complications and address aspects that may not be completely within the domain of individual specialists.

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The high-risk surgical patient: a role for a multi-disciplinary team approach?

Cited by 40 publications

References 16 publications

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

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

Organization of Multidisciplinary Cancer Care for the Surgical Patient: Role of Anesthesiologists

Aortic arch surgery for type B aortic dissection: How far should we go? The value of a hybrid approach

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