A Multidisciplinary High-Risk Surgery Committee May Improve Perioperative Decision Making for Patients and Physicians.

Autor: Jones TS; Department of Surgery, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA.; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.; Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA., Jones EL; Department of Surgery, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA.; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA., Barnett CC Jr; Department of Surgery, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA.; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA., Moore JT; Department of Surgery, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA.; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA., Wikiel KJ; Department of Surgery, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA.; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA., Horney CP; Geriatrics Section, Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA., Unruh M; Palliative Care Section, Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA., Levy CR; Palliative Care Section, Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.; Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, Colorado, USA.; Division of Health Care Policy and Research, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA., Robinson TN; Department of Surgery, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA.; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
Jazyk: angličtina
Zdroj: Journal of palliative medicine [J Palliat Med] 2021 Dec; Vol. 24 (12), pp. 1863-1866.
DOI: 10.1089/jpm.2021.0141
Abstrakt: Background: Surgeons must evaluate and communicate the risk associated with operative procedures for patients at high risk of poor postoperative outcomes. Multidisciplinary approaches to complex decision making are needed. Objective: To improve physician decision making for high-risk surgical patients. Design: This is a retrospective review of patients presented to a multidisciplinary committee for three years. Setting/Subjects: Evaluation of patients was done in a single-center U.S. veterans affairs (VA) hospital. All patients who were considered for surgery had a VA Surgical Quality Improvement Program (VASQIP) risk calculator 30-day mortality >5%. Measurements: Thirty-day and one-year mortality were measured. Results: Seventy-six patients were reviewed with an average expected 30-day mortality of 14.2%. Forty-two patients (57%) had a recommended change in the care plan before surgery. Fifty-four patients (71%) proceeded with surgery and experienced a 30-day mortality of 7.4%. Conclusions and Relevance: Multidisciplinary discussion of high-risk surgical patients may help surgeons make perioperative recommendations for patients. Implementation of a multidisciplinary high-risk committee should be considered at facilities that manage high-risk surgical patients.
Databáze: MEDLINE
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