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. 2024 Aug;168(2):608-616.e5.
doi: 10.1016/j.jtcvs.2023.05.037. Epub 2023 Jun 10.

The association between preoperative multidisciplinary team care and patient outcome in frail patients undergoing cardiac surgery

Rosa M Smoor  1 , Eric P A van Dongen  2 , Edgar J Daeter  3 , Marielle H Emmelot-Vonk  4 , Olaf L Cremer  5 , Lisette M Vernooij  1 , Peter G Noordzij  6
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The association between preoperative multidisciplinary team care and patient outcome in frail patients undergoing cardiac surgery

Rosa M Smoor et al. J Thorac Cardiovasc Surg. 2024 Aug.

Abstract

Objective: To evaluate the influence of preoperative multidisciplinary team (MDT) care on perioperative management and outcomes of frail patients undergoing cardiac surgery.

Background: Frail patients are at increased risk for complications and poor functional outcome after cardiac surgery. In these patients, preoperative MDT care may improve outcomes.

Methods: Between 2018 and 2021, 1168 patients aged 70 years or older were scheduled for cardiac surgery, of whom 98 (8.4%) frail patients were referred for MDT care. The MDT discussed surgical risk, prehabilitation, and alternative treatment. Outcomes of MDT patients were compared with 183 frail patients (non-MDT group) from a historical study cohort (2015-2017). Inverse probability of treatment weighting was used to minimize bias from nonrandom allocation of MDT versus non-MDT care. Outcomes were severe postoperative complications, total days in hospital after 120 days, disability, and health-related quality of life after 120 days.

Results: This study included 281 patients (98 MDT and 183 non-MDT patients). Of the MDT patients, 67 (68%) had open surgery, 21 (21%) underwent minimally invasive procedures, and 10 (10%) received conservative treatment. In the non-MDT group, all patients had open surgery. Fourteen (14%) MDT patients experienced a severe complication versus 42 (23%) non-MDT patients (adjusted relative risk, 0.76; 95% CI, 0.51-0.99). Adjusted total days in hospital after 120 days was 8 days (interquartile range, 3-12 days) versus 11 days (interquartile range, 7-16 days) for MDT and non-MDT patients, respectively (P = .01). There was no difference in disability or health-related quality of life.

Conclusions: Preoperative MDT care for frail patients undergoing cardiac surgery is associated with alterations in surgical management and with a lower risk for severe complications.

Keywords: frailty; multidisciplinary team care; older patients; treatment decision making.

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