Does preoperative multidisciplinary team assessment of high-risk patients improve the safety and outcomes of patients undergoing surgery?

BACKGROUND: International guidelines recommend preoperative multidisciplinary team (MDT) assessment for high-risk surgical patients. Preoperative MDT meetings can help to improve surgical care, but there is little evidence on whether they improve patient outcomes. METHODS: This paper aims to share our experience of MDT meetings for high-risk surgical patients to underline their added value to the current standard of care. An observational study of a retrospective cohort of preoperative high-risk MDT meetings of a tertiary referral hospital between January 2015 and December 2020. For 249 patients the outcomes preoperative data, MDT decisions, and patient outcomes were collected from electronic health records. MAIN RESULTS: A total of 249 patients were discussed at high-risk MDT meetings. Most of the patients (97%) were assessed as having an American Society of Anesthesiology score ≥ 3, and 219 (88%) had a European Society of Cardiology and European Society of Anaesthesiology risk score of intermediate or high. After MDT assessment, 154 (62%) were directly approved for surgery, and 39 (16%) were considered ineligible for surgery. The remaining 56 (23%) patients underwent additional assessments before reconsideration at a high-risk MDT meeting. The main reason for patients being discussed at the high-risk MDT meeting was to assess the risk-benefit ratio of surgery. Ultimately, 184 (74%) patients underwent surgery. Of the operated patients, 122 (66%) did not have a major complication in the postoperative period, and 149 patients (81%) were alive after one year. CONCLUSIONS: This cohort study shows the vulnerability and complexity of high-risk patients but also shows that the use of an MDT assessment contributes too improved peri- and postoperative treatment strategies in high-risk patients. Most patients underwent surgery after careful risk assessment and, if deemed necessary, preoperative and perioperative treatment optimization to reduce their risk.

Delivery of Nutritious Meals to Elderly Receiving Home Care: Feasibility and Effectiveness.

BACKGROUND/OBJECTIVES: Elderly with functional disabilities are at increased risk of inadequate dietary intake. Little is known about the effectiveness of interventions aimed at improving their dietary intake and nutritional status, nor about the determinants of successful implementation. We performed a feasibility study to evaluate the implementation and effectiveness of a home delivery service providing nutritious meals. DESIGN: Quasi-experimental, with participants allocated to treatment group based on municipality of residence. SETTING AND PARTICIPANTS: Functionally disabled home-dwelling elderly receiving home care. INTERVENTION: Three-month daily meal service consisting of dinner and snacks (intervention). The control group sustained habitual food intake. MEASUREMENTS: Data on satisfaction and problems regarding the meal service were collected by structured interviews. Dietary intake (2-day estimated food diary), nutritional status (anthropometry), handgrip strength, and quality of life (questionnaire-based) was measured at baseline, three months (end of intervention), and six months (follow-up). RESULTS: Forty-four elderly were included (intervention group: 25, control group: 19). For most aspects of the meal service, approximately 90% of participants indicated being satisfied, and the large majority (70%) was interested in receiving a similar meal service in the future. At the end of the 3-month intervention, the intervention group showed a greater increase than the control group in body weight (P< 0.005), body mass index (P< 0.005), upper leg circumference (P< 0.01) and fat free mass (FFM, P< 0.03). Three months post-intervention, only the increase in FFM remained statistically significant (P< 0.05). Except for calcium intake, no positive intervention effect was observed for any of the other outcomes. CONCLUSION: Our study stresses the feasibility as well as the potential of healthy and tasteful meals to support home-dwelling elderly, by showing that a high-quality meal service was highly appreciated and had a rapid effect on FFM.