Anokwute Miracle C, Preda Veronica, Di Ieva Antonio
Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia; Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
World Neurosurg. 2023 Apr;172:73-80. doi: 10.1016/j.wneu.2023.01.079. Epub 2023 Feb 7.
The integration of multidisciplinary team meetings (MDTMs) for neurosurgical care has been accepted worldwide. Our objective was to review the literature for the limiting factors to MDTMs that may introduce bias to patient care.
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used to perform a literature review of MDTMs for neuro-oncology, pituitary oncology, cerebrovascular surgery, and spine surgery and spine oncology. Limiting factors to productive MDTMs and factors that introduce bias were identified, as well as determining whether MDTMs led to improved patient outcomes.
We identified 1264 manuscripts from a PubMed and Ovid Medline search, of which 27 of 500 neuro-oncology, 4 of 279 pituitary, and 11 of 260 spine surgery articles met our inclusion criteria. Of 224 cerebrovascular manuscripts, none met the criteria. Factors for productive MDTMs included quaternary/tertiary referral centers, nonhierarchical environment, regularly scheduled meetings, concise inclusion of nonmedical factors at the same level of importance as patient clinical information, inclusion of nonclinical participants, and use of clinical guidelines and institutional protocols to provide recommendations. Our review did not identify literature that described the use of artificial intelligence to reduce bias and guide clinical care.
The continued implementation of MDTMs in neurosurgery should be recommended but cautioned by limiting bias.
神经外科护理多学科团队会议（MDTMs）的整合已在全球范围内得到认可。我们的目的是回顾文献，找出可能给患者护理带来偏差的MDTMs的限制因素。
采用系统评价和Meta分析的首选报告项目，对神经肿瘤学、垂体肿瘤学、脑血管外科、脊柱外科和脊柱肿瘤学的MDTMs进行文献综述。确定了高效MDTMs的限制因素和导致偏差的因素，以及MDTMs是否能改善患者预后。
通过PubMed和Ovid Medline检索，我们识别出1264篇手稿，其中500篇神经肿瘤学文章中的27篇、279篇垂体肿瘤学文章中的4篇以及260篇脊柱外科文章中的11篇符合我们的纳入标准。224篇脑血管手稿均不符合标准。高效MDTMs的因素包括四级/三级转诊中心、非等级环境、定期安排会议、将非医疗因素与患者临床信息以同等重要程度简洁纳入、纳入非临床参与者，以及使用临床指南和机构规程提供建议。我们的综述未发现描述使用人工智能减少偏差并指导临床护理的文献。
应建议在神经外科持续实施MDTMs，但要注意限制偏差。
