Key result
Preoperative multidisciplinary conferences are linked to ~12% altered high-risk treatment plans, mostly via procedure cancellation.
Why the study?
Complex factors including age, comorbidities, and patient preferences make it challenging for surgeons to independently determine treatment plans for high-risk surgical patients.
Does a preoperative multidisciplinary conference alter treatment plans in high-risk surgical patients?
Observational (n=406)
No
Does a preoperative multidisciplinary conference alter treatment plans in high-risk surgical patients?
Preoperative multidisciplinary conferences for high-risk surgical patients led to treatment plan modifications in 12% of cases, often resulting in more conservative approaches.
May support preoperative review in select high-risk cases; leaves open effects on outcomes and need for randomized evaluation.
BACKGROUND: Surgical options for patients vary with age and comorbidities, advances in medical technology and patients' wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee. METHODS: In this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018. RESULTS: A total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported. CONCLUSIONS: Given that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.
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Koike et al. (2021) conducted an observational in High-risk patients with challenging surgical treatment options (n=406). Preoperative multidisciplinary conference (High-Risk Conference) was evaluated on Change in treatment plan (surgical modification or cancellation). A preoperative multidisciplinary conference for high-risk surgical patients resulted in treatment plan changes for 12% of patients, primarily involving procedure reduction or cancellation.
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