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Kuiper BI, Janssen LMJ, Versteeg KS, Ten Tusscher BL, van der Spoel JI, Lubbers WD, Kazemier G, Loer SA, Schober P, van Halm VP. Does preoperative multidisciplinary team assessment of high-risk patients improve the safety and outcomes of patients undergoing surgery? BMC Anesthesiol 2024; 24:9. [PMID: 38166642 PMCID: PMC10759340 DOI: 10.1186/s12871-023-02394-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
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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Affiliation(s)
- B I Kuiper
- Department of Surgery, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - L M J Janssen
- Department of Anesthesiology, Amsterdam UMC location VUmc, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.
| | - K S Versteeg
- Department of Internal medicine, section geriatrics, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - B L Ten Tusscher
- Department of Intensive Care Medicine, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - J I van der Spoel
- Department of Intensive Care Medicine, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - W D Lubbers
- Department of Anesthesiology, Amsterdam UMC location VUmc, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - G Kazemier
- Department of Surgery, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S A Loer
- Department of Anesthesiology, Amsterdam UMC location VUmc, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - P Schober
- Department of Anesthesiology, Amsterdam UMC location VUmc, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - V P van Halm
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
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Vernooij JEM, Boerlage RM, Doggen CJM, Preckel B, Dirksen CD, van Leeuwen BL, Spruit RJ, Festen S, van der Wal-Huisman H, van Basten JP, Kalkman CJ, Koning NJ. 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. Trials 2023; 24:660. [PMID: 37821994 PMCID: PMC10568883 DOI: 10.1186/s13063-023-07685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023] Open
Abstract
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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Affiliation(s)
- Jacqueline E M Vernooij
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands.
- Department of Anesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Romijn M Boerlage
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschedé, The Netherlands
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam Public Health, Quality of Care, Amsterdam Cardiovascular Science, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - Carine J M Doggen
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschedé, The Netherlands
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands
| | - Benedikt Preckel
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam Public Health, Quality of Care, Amsterdam Cardiovascular Science, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - Carmen D Dirksen
- Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rutger J Spruit
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Suzanne Festen
- University Center for Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Hanneke van der Wal-Huisman
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jean P van Basten
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Cor J Kalkman
- Department of Anesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Nick J Koning
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands
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