Is there a role for the high-risk multidisciplinary team meeting in thoracic surgery?

Nwaejike, Nnamdi; Elbur, Ehab; Malagon, Ignacio; Dodman, Natalie; Hewitt, Kath; Fontaine, Eustace; Krysiak, Piotr; Jones, Mark R.; Rammohan, Kandadai

doi:10.1093/icvts/ivv389

Cited by 10 publications

(4 citation statements)

References 5 publications

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“…Similarly, in dealing with patients with a complex disease that requires frequent office visits, hospital admissions, and various home services, the role of an effective social worker appears critical. Furthermore, multidisciplinary meetings have been shown to positively affect patient assessment, management practices, and outcomes across specialties 24–27 . Although data on meeting frequency and outcome measures are unclear, open and streamlined communication between various team members is a critical component of effective team processes and includes structured and regularly scheduled meetings 22 .…”

Section: Discussionmentioning

confidence: 99%

National Survey of Pediatric Intestinal Rehabilitation Programs in the United States

Park

Shaughnessy

Zhang

et al. 2020

J Parenter Enteral Nutr

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Background Pediatric intestinal rehabilitation (PIR) programs are associated with improved outcomes in children with intestinal failure but remain heterogeneous nationally. This study characterizes PIR program components to aid those seeking to establish or expand a program. Methods Members of the Children's Hospital Association reporting a PIR program to the US News and World Report completed a 14‐item questionnaire using the Qualtrics Online Survey Software. Programs were categorized as small or large (≤50 vs >50 patients) and new or established (≤10 vs >10 years). Results Seventy‐one programs were identified and 61 surveys were returned for a response rate of 86%. Majority of programs had gastroenterology, surgery, nutrition, nursing, and social work services involved. Large programs (n = 34; 59%) were more likely to serve as referral centers; have greater participation by nursing, social work, and primary care; have more dedicated time by gastroenterology, surgery, nursing, nutrition, and social work; have more frequent meetings; and have various funding sources (P < .05). Conclusion Critical components of a PIR program include gastroenterology, surgery, and nutrition services with strong nursing and social work support. These data document the components of modern PIR programs, though further studies on the relationship between program structure and patient outcomes are warranted.

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Section: Discussionmentioning

confidence: 99%

National Survey of Pediatric Intestinal Rehabilitation Programs in the United States

Park

Shaughnessy

Zhang

et al. 2020

J Parenter Enteral Nutr

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“…Latterly, endobronchial ultrasound transbronchial needle aspiration, cranial magnetic resonance imaging, transthoracic echocardiogram and exercise testing (either shuttle walk test or cardiopulmonary exercise testing) were also undertaken routinely. A multidisciplinary team assessed each case prior to surgery and all patients were also discussed at specially convened high-risk multidisciplinary team meetings [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

Pneumonectomy for primary lung cancer: contemporary outcomes, risk factors and model validation

Brunswicker

Taylor

Grant

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES Despite the increased rate of adverse outcomes compared to lobectomy, for selected patients with lung cancer, pneumonectomy is considered the optimal treatment option. The objective of this study was to identify risk factors for mortality in patients undergoing pneumonectomy for primary lung cancer. METHODS Data from all patients undergoing pneumonectomy for primary lung cancer at 2 large thoracic surgical centres between 2012 and 2018 were analysed. Multivariable logistic and Cox regression analyses were used to identify risk factors associated with 90-day and 1-year mortality and reduced long-term survival, respectively. RESULTS The study included 256 patients. The mean age was 65.2 (standard deviation 9.4) years. In-hospital, 90-day and 1-year mortality were 6.3% (n = 16), 9.8% (n = 25) and 28.1% (n = 72), respectively. The median follow-up time was 31.5 months (interquartile range 9–58 months). Patients who underwent neoadjuvant therapy had a significantly increased risk of 90-day [odds ratio 6.451, 95% confidence interval (CI) 1.867–22.291, P = 0.003] and 1-year mortality (odds ratio 2.454, 95% CI 1.079–7.185, P = 0.044). Higher Performance Status score was associated with higher 1-year mortality (odds ratio 2.055, 95% CI 1.248–3.386, P = 0.005) and reduced overall survival (hazard ratio 1.449, 95% CI 1.086–1.934, P = 0.012). Advanced (stage III/IV) disease was associated with reduced overall survival (hazard ratio 1.433, 95% CI 1.019–2.016, P = 0.039). Validation of a pneumonectomy-specific risk model demonstrated inadequate model performance (area under the curve 0.54). CONCLUSIONS Pneumonectomy remains associated with a high rate of perioperative mortality. Neoadjuvant chemoradiotherapy, Performance Status score and advanced disease emerged as the key variables associated with adverse outcomes after pneumonectomy in our cohort.

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“…Riskstratification models, such as Thoracoscore for thoracic surgery, are used as aids to augment the decision-making process. However, it is well recognised that Thoracoscore does not predict mortality equally accurately across all patient groups (22), perhaps as a result of changing patient characteristics since its inception, and hence the predictions made by these tools must be considered alongside other components of the pre-operative decision-making process, such as objective functional testing and multidisciplinary team meetings convened specifically to discuss high-risk patients (23). Final decisions regarding treatment should be made on an individual case by case basis.…”

Section: Pre-operative Identification Of the High-risk Patientmentioning

confidence: 99%

Aetiology, management and strategies for prevention of postoperative respiratory failure (PORF) after thoracic surgery

Taylor¹,

Charlesworth²,

Hayes³

et al. 2021

Shanghai Chest

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BackgroundLung cancer is the third most common cancer in the UK with over 47,000 new diagnoses each year. The National Cancer Registration and Analysis Service has quoted that the proportion of patients with non-small cell lung cancer (NSCLC) undergoing surgery each year in the UK was approximately 16% between 2013 and 2015, which represents a marked increase from the 8.8% and 10.6% quoted for 1998 and 2008 respectively (1). Following surgery for lung cancer, the 30-day mortality rate is approximately 2%, and rises to around 5% at 90 days. Oneyear survival after lung cancer surgery is around 88% (2).Reduction of mortality and morbidity after lung cancer surgery is as an important component of improving lung cancer survival. This is because most patients undergoing surgery are early stage (stage I and II) lung cancer patients. Hence, if survival in this group of patients can be optimised, it is likely to have a significant (and disproportionate) impact on overall lung cancer survival rates, because if these patients survive the perioperative period they are much more likely to survive to five years and beyond as compared with patients with more advanced lung cancer. Complications after thoracic surgeryDevelopment of post-operative complications is associated with poor patient satisfaction (3), prolonged critical care and overall hospital stay, increased healthcare costs and increased mortality. Post-operative complications after thoracic surgery occur in around 15-40% of patients (4). Moreover, the incidence of even a single post-operative complication can lead to additional adverse outcomes (5). Studies looking to reduce rates of complications in this patient group have identified several risk factors associated with complications after thoracic surgery. Interventions aimed at modifying these risk factors could therefore logically lead to better outcomes and improved survival

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Is there a role for the high-risk multidisciplinary team meeting in thoracic surgery?

Cited by 10 publications

References 5 publications

National Survey of Pediatric Intestinal Rehabilitation Programs in the United States

National Survey of Pediatric Intestinal Rehabilitation Programs in the United States

Pneumonectomy for primary lung cancer: contemporary outcomes, risk factors and model validation

Aetiology, management and strategies for prevention of postoperative respiratory failure (PORF) after thoracic surgery

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