Department of Anesthesiology, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
BMC Anesthesiol. 2021 Feb 6;21(1):39. doi: 10.1186/s12871-021-01257-1.
Surgical options for patients vary with age and comorbidities, advances in medical technology and patients' wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee.
In this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018.
A total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported.
Given that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.
患者的手术选择因年龄和合并症、医疗技术的进步以及患者的意愿而异。这种复杂性使得外科医生难以独立确定适当的治疗计划。在我们的机构中，最终的治疗决策是在多学科会议上做出的，这些会议称为高风险会议，由患者安全委员会领导。
在这项回顾性研究中，我们使用会议记录和患者病历评估了召开高风险会议的原因、最终决策以及治疗结果，这些记录是针对我们机构在 2010 年 4 月至 2018 年 3 月期间举行的会议。
在研究期间，共为 406 名患者举行了 410 次高风险会议。会议最多的科室是心血管外科（24%），召开会议的原因包括存在严重合并症（51%）、手术难度大（41%）和非医疗/个人问题（8%）。有 49 名患者（12%）的治疗方案发生了变化，其中 20 名患者进行了手术修改，29 名患者取消了手术。最常见的手术修改是减少手术程序（16 名患者）；报告了 4 例死亡。取消手术的 21 名患者中有 21 名患者进行了随访，报告了 11 例死亡。
鉴于在高风险会议上讨论的患者中有 12%的患者改变了治疗计划，我们得出结论，这些会议的参与者并不总是同意最初的手术计划，会议的多学科决策过程允许进行修改。许多修改涉及减少手术程序，以反映更保守的方法，这可能降低围手术期死亡率和并发症发生率，以及不必要的手术。高危患者存在复杂的问题，从统计学上验证治疗方案的改变是否与结果相关是困难的。然而，从患者安全的角度来看，这些会议可能是有用的，并最大限度地减少潜在的法律纠纷。
