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

B I Kuiper; L M J Janssen; K S Versteeg; B L Ten Tusscher; J I van der Spoel; W D Lubbers; G Kazemier; S A Loer; P Schober; V P van Halm

doi:10.1186/s12871-023-02394-5

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

BMC Anesthesiol. 2024 Jan 2;24(1):9. doi: 10.1186/s12871-023-02394-5.

Authors

B I Kuiper^#^{1

2}, L M J Janssen^#³, K S Versteeg⁴, B L Ten Tusscher⁵, J I van der Spoel⁵, W D Lubbers⁶, G Kazemier^{1

2}, S A Loer⁶, P Schober⁶, V P van Halm⁷

Affiliations

¹ Department of Surgery, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.
² Cancer Center Amsterdam, Amsterdam, The Netherlands.
³ Department of Anesthesiology, Amsterdam UMC location VUmc, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands. liedewij.janssen@amsterdamumc.nl.
⁴ Department of Internal medicine, section geriatrics, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.
⁵ Department of Intensive Care Medicine, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.
⁶ Department of Anesthesiology, Amsterdam UMC location VUmc, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.
⁷ Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.

^# Contributed equally.

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.

Keywords: Anesthesia; Frailty; High-risk surgery; Multidisciplinary team; Preoperative consultation.

Publication types

Observational Study

MeSH terms

Anesthesiology*
Cohort Studies
Humans
Patient Care Team*
Retrospective Studies