Department of Surgery, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.
Cancer Center Amsterdam, Amsterdam, The Netherlands.
BMC Anesthesiol. 2024 Jan 2;24(1):9. doi: 10.1186/s12871-023-02394-5.
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.
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.
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.
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.
国际指南建议对高风险手术患者进行术前多学科团队（MDT）评估。术前 MDT 会议有助于改善手术护理，但几乎没有证据表明它们是否改善了患者的预后。
本文旨在分享我们对高风险手术患者 MDT 会议的经验，以强调其对当前护理标准的附加价值。这是一项对 2015 年 1 月至 2020 年 12 月期间一家三级转诊医院的术前高风险 MDT 会议的回顾性队列的观察性研究。从电子病历中收集了 249 例患者的术前数据、MDT 决策和患者预后。
共有 249 例患者在高风险 MDT 会议上进行了讨论。大多数患者（97%）的美国麻醉医师协会评分≥3，219 例（88%）的欧洲心脏病学会和欧洲麻醉学会风险评分中等或高。经过 MDT 评估后，154 例（62%）直接批准手术，39 例（16%）被认为不适合手术。其余 56 例（23%）患者在高风险 MDT 会议上重新考虑之前接受了额外评估。患者在高风险 MDT 会议上讨论的主要原因是评估手术的风险效益比。最终，184 例（74%）患者接受了手术。在接受手术的患者中，122 例（66%）在术后期间没有发生重大并发症，149 例（81%）在一年后存活。
本队列研究显示了高风险患者的脆弱性和复杂性，但也表明使用 MDT 评估有助于改善高风险患者的围手术期治疗策略。大多数患者在经过仔细的风险评估后接受了手术，如果有必要，还进行了术前和围手术期治疗优化，以降低风险。
