Role of a Multidisciplinary Meeting for High-Risk Patients Considered for Vascular Surgery: Early and Mid-Term...

Patients requiring aortoiliac surgery are often elderly and multimorbid. This study describes pathology, decision-making, short and long-term outcomes for all aortoiliac patients referred to a high-risk multidisciplinary meeting (MDM).

Retrospective cohort study of all patients referred to a high-risk MDM for consideration of aortoiliac intervention at a tertiary centre between February 2011 and December 2024, with follow up of survival until March 2025.

Data were extracted from MDM minutes, electronic records and national mortality database. Post-operative outcomes, including mortality and Days Alive and Out of Hospital within 90 days of surgery (DAOH₉₀), and 2 and 5 year survival for intention for surgery cohort, and those declined.

Of 381 patients reviewed, 158 were initially accepted, 69 declined and 154 deferred for investigation or optimisation. Declined patients were older (median 80 vs. 73 years; p < 0.001) and had higher rates of cognitive impairment, chronic kidney disease and end-stage renal disease (all p < 0.001). Nine died during optimisation and three awaiting surgery. Post-operative mortality was 3.3% (8) at 30 days and 5.7% (14) at 90 days. A total 242 patients underwent intervention, at a median 54 (IQR 27-115) days from first discussion. Two- and five-year survival in the intention-to-treat cohort were 89.3% and 74.0%, compared with 57.1% and 29.8% for those declined (p < 0.001).

Formal MDM assessment optimised and cleared 63.5% high-risk patients referred with aortoiliac pathology. Those declined had significantly reduced survival, with the majority dying from comorbidities. Preoperative investigations need to be carefully selected and prioritised, as delays can result in morbidity and mortality.