Lipson Patricia, de Oliveira Rafael Garcia, Fujii Takeshi, Leveque Jean-Christophe, Nemani Venu M, Louie Philip K, Sethi Rajiv K
School of Medicine, University of Washington, Seattle, WA, USA.
Center for Neuroscience and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, USA.
Spine Deform. 2025 May 5. doi: 10.1007/s43390-025-01099-8.
Assess patient experiences and outcomes following a multidisciplinary conference recommendation against surgery, including the proportion who later pursued surgery elsewhere and their outcomes.
We performed a retrospective analysis of patients advised against surgery during our internal multidisciplinary ASD conference. A phone-based survey gathered on patient satisfaction, effectiveness of alternative treatments, rates of operations at outside hospitals, and subsequent rates of complications, reoperations, and readmissions among those who underwent surgery.
One hundred one patients had an evaluation by a multidisciplinary conference from 2015 to 2024 with an initial recommendation against surgery; 9 later met surgical criteria and underwent surgery with our group, while 17 died before this study. Of the remaining 75, 2 were unable to participate due to medical reasons, and 33 were unreachable, leaving 40 survey participants. Nine declined to answer, and thirty-one completed the survey. Among respondents, 71% were satisfied with the recommendation against surgery, and 38.7% sought a second opinion. Of those, 41.7% (5/12) were recommended surgery, and 33% (4/12) underwent surgery elsewhere with minimal complications. Most respondents rated their quality of life as 'acceptable' and used physical therapy and pain management for symptom control.
While most patients were satisfied with our recommendation against surgery, a notable subset sought second opinions, and some ultimately underwent successful surgery. These findings highlight the need for periodic reassessment of multidisciplinary conference criteria to ensure optimal patient outcomes.
评估在多学科会议建议不进行手术之后患者的体验和结局，包括后来在其他地方寻求手术治疗的患者比例及其结局。
我们对在我院内部多学科先天性心脏病会议期间被建议不进行手术的患者进行了回顾性分析。通过电话调查收集了患者满意度、替代治疗的有效性、外部医院的手术率，以及接受手术患者随后的并发症发生率、再次手术率和再入院率。
2015年至2024年期间，101例患者经多学科会议评估，最初建议不进行手术；其中9例后来符合手术标准并在我院接受了手术，17例在本研究之前死亡。其余75例中，2例因医疗原因无法参与，33例无法联系到，最终有40例参与了调查。9例拒绝回答，31例完成了调查。在受访者中，71%对不进行手术的建议感到满意，38.7%寻求了第二种意见。其中，41.7%（5/12）被建议进行手术，33%（4/12）在其他地方接受了手术，并发症极少。大多数受访者将他们的生活质量评为“可接受”，并使用物理治疗和疼痛管理来控制症状。
虽然大多数患者对我们不进行手术的建议感到满意，但有相当一部分患者寻求了第二种意见，一些患者最终成功接受了手术。这些发现凸显了定期重新评估多学科会议标准以确保患者获得最佳结局的必要性。
