A novel anesthesiologist‐led multidisciplinary model for evaluating high‐risk surgical patients at a comprehensive cancer center

Sroka, Raymond; Gabriel, Emmanuel; Al-Hadidi, Danna; Nurkin, Steven; Urman, Richard D.; Quinn, Timothy D.

doi:10.1002/jhrm.21326

Cited by 17 publications

(9 citation statements)

References 40 publications

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“…At our institution, the utility of decision making across multiple disciplines was quickly recognized, and High-Risk Conferences have been held since April 2010. Several reports on high-risk conferences have been published [12][13][14]; however, they appeared to focus more on process. We analyzed outcomes for numerous patients after High-Risk Conferences, particularly those for whom procedures were modified or cancelled.…”

Section: Discussionmentioning

confidence: 99%

“…We analyzed outcomes for numerous patients after High-Risk Conferences, particularly those for whom procedures were modified or cancelled. Sroka et al reported on the utility of high-risk conferences at a cancer center [14]. In that study, discussions of medical comorbidities were the main focus, and anesthesiologists usually took the initiative at the conferences.…”

Section: Discussionmentioning

confidence: 99%

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The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

et al. 2021

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

et al. 2021

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“…Besides promoting patient-centered care it may further improve clinical outcome and reduce resource overuse [47,48]. As a multidisciplinary process, shared decisionmaking implies a discussion between the patient and their healthcare providers, including surgeons and anesthesiologists [49]. After carefully evaluating all medical and surgical treatment options including scientific evidence, advantages, disadvantages, prognosis, risks and benefits, an individualized care plan is customized for each patient according to his physical condition, goals, and expectations [48].…”

Section: Meeting Patients' Expectations -What Do They Need?mentioning

confidence: 99%

Modern preoperative evaluation in ambulatory surgery – who, where and how?

Filipovic

Schwenter

Luedi

et al. 2022

Current Opinion in Anaesthesiology

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Purpose of reviewAmbulatory surgery is increasingly performed in medically complex patients. This dynamic environment requires new approaches to ensure cost-effective, efficient, and ultimately safe preoperative evaluation of the patient. This review investigates recent advances in the assessment of ambulatory patients, with a special focus on patient screening, digital communication, and multidisciplinary team evaluation.Recent findingsIdentifying suitable candidates for ambulatory surgery relies on a variety of medical, surgical, and institutional factors. Identification of high-risk patients and optimization of their treatment can be achieved through multidisciplinary protocols specific to the local institution and in line with current guidelines. Virtual assessment may be sufficient for most patients and provide an efficient evaluation strategy and high patient satisfaction. Prescreening can be supported by preoperative nursing teams.SummaryThe increasing complexity of treatment provided in day surgery offers a unique opportunity to highlight the importance of anesthesiology staff as perioperative caregivers. Preoperative evaluation serves as a central junction to integrate a variety of surgical, medical, and institutional factors to provide safe, satisfactory, and efficient care for patients. Implementing technological innovation to streamline and facilitate this process is paramount.

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“…Anesthesia providers as perioperative clinicians are in a unique position to coordinate interdisciplinary conversations that incorporate patient goal concordant care and realistic assessment of perioperative complications based on the patient's comorbidities [18,19]. As facilitators of these complex perioperative discussions, anesthesia providers must be equipped to assess a patient's decision-making capacity before embarking on advance care planning [20].…”

Section: Shared Decision-makingmentioning

confidence: 99%

Addressing comorbidities in the perioperative setting and optimizing perioperative medicine education

Krishnan

Adeola

Urman

2022

Current Opinion in Anaesthesiology

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Purpose of reviewPreoperative clinics and patient optimization are examples of collaborative, multidisciplinary care pathways that create value. This article reviews current literature to demonstrate the importance of preoperative enhancement of patients’ cognitive and functional status. This article underscores the importance of formal training in multidisciplinary topics, such as frailty, brain health, and shared decision-making for anesthesiology house staff.Recent findingsPreoperative cognitive screening of older patients is a valuable metric for risk stratification and detection of patients at risk of postoperative delirium. Frailty is another syndrome that can be identified and optimized preoperatively. Sarcopenia has been shown to correlate with frailty; this shows promise as a method to detect frailty preoperatively.SummaryAnesthesiologists as perioperative physicians are in a unique position to lead and coordinate interdisciplinary conversations that incorporate patient goal concordant care and realistic assessment of perioperative complications. Formal house staff training in early recognition and management of patients at risk of adverse outcomes in the short and long term postoperatively improves patient outcomes and decreases healthcare spending.

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A novel anesthesiologist‐led multidisciplinary model for evaluating high‐risk surgical patients at a comprehensive cancer center

Cited by 17 publications

References 40 publications

The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

Modern preoperative evaluation in ambulatory surgery – who, where and how?

Addressing comorbidities in the perioperative setting and optimizing perioperative medicine education

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