Characteristics and outcome of preoperative multidisciplinary team discussions for high-risk noncardiac surgical...

Guidelines recommend preoperative multidisciplinary team (MDT) discussions for high-risk noncardiac surgical patients, but there is a lack of guidance and underlying evidence. The present study aims to describe the characteristics of MDT meetings and their effect on 30-day patient outcomes.

A prospective, multicentre, observational study was conducted in nine hospitals in the Netherlands. From each hospital, 25 consecutive adult high-risk noncardiac surgical patients discussed in a preoperative MDT meeting were included. Data were collected between April 2022 and September 2023, including patient and MDT characteristics, clinical information, and patient outcomes up to 30 days after surgery.

The present study included 225 patients, with a median age of 73 yr (interquartile range 64-79 yr). Patients were selected for an MDT discussion because of doubt regarding the harm-benefit ratio of the proposed surgery (n=168; 75%) or as part of a standardised surgical pathway (n=57; 25%). Clinical management was modified after MDT discussions for 183 (81%) patients, including 71 patients (32%) who underwent nonsurgical management after MDT discussion. Within 30 days after surgery, 75 patients (49%) experienced adverse events, compared with 16 patients (23%) after nonsurgical management. The 30-day mortality rate was 3% after surgery and 11% after nonsurgical management.

Preoperative MDT discussions lead to management modifications for high-risk noncardiac surgical patients. Almost one-third of the discussed patients did not undergo surgery. The rate of postoperative adverse events was high in this selected population. Further research is needed to evaluate the effectiveness of MDT decisions on the quality of life and disability experienced by these patients.

ClinicalTrials.gov NCT05703230 (registered on Mar 22, 2022).