1. Does preoperative multidisciplinary team assessment of high-risk patients improve the safety and outcomes of patients undergoing surgery?
- Author
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Kuiper, B. I., Janssen, L.M.J., Versteeg, K. S., ten Tusscher, B. L., van der Spoel, J. I., Lubbers, W. D., Kazemier, G., Loer, S. A., Schober, P., and van Halm, V. P.
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PREOPERATIVE care , *MEDICAL quality control , *SCIENTIFIC observation , *ANESTHESIOLOGY , *OPERATIVE surgery , *RETROSPECTIVE studies , *ACQUISITION of data , *SURGICAL complications , *RISK assessment , *TREATMENT effectiveness , *MEDICAL protocols , *HEALTH care teams , *MEDICAL records , *POSTOPERATIVE period , *DESCRIPTIVE statistics , *PATIENT safety , *LONGITUDINAL method - 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. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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