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Is a preoperative multidisciplinary team meeting (cost)effective to improve outcome for high-risk adult patients undergoing noncardiac surgery: the PREPARATION study—a multicenter stepped-wedge cluster randomized trial.

Authors :
Vernooij, Jacqueline E. M.
Boerlage, Romijn M.
Doggen, Carine J. M.
Preckel, Benedikt
Dirksen, Carmen D.
van Leeuwen, Barbara L.
Spruit, Rutger J.
Festen, Suzanne
van der Wal-Huisman, Hanneke
van Basten, Jean P.
Kalkman, Cor J.
Koning, Nick J.
van der Sloot, Koene
Dias, Esther M.
Kal, Jasper E.
van den Nieuwenhuyzen, Marjolein C. O.
di Biase, Manuela
Hagenaars, Martin
Oedairadjsingh, Bies
van den Ende, Taco
Source :
Trials. 10/11/2023, Vol. 24 Issue 1, p1-11. 11p. 1 Diagram, 3 Charts.
Publication Year :
2023

Abstract

Background: As a result of increased life expectancy and improved care for patients suffering from chronic disease, the number of patients with multimorbidity requiring surgical intervention is increasing. For complex surgical patients, it is essential to balance the potential benefits of surgical treatment against the risk of permanent loss of functional capacity and quality of life due to complications. European and US guidelines on perioperative care recommend preoperative multidisciplinary team (MDT) discussions for high-risk noncardiac surgical patients. However, the evidence underlying benefits from preoperative MDT meetings with all relevant perioperative specialties present is limited. The current study aims to investigate the effect of implementation of preoperative MDT discussions for high-risk patients undergoing noncardiac surgery on serious adverse events. Methods/design: PREPARATION is a stepped-wedge cluster randomized trial in 14 Dutch hospitals without currently established preoperative MDT meeting. The intervention, preoperative MDT meetings, will be implemented sequentially with seven blocks of 2 hospitals switching from control (preoperative screening as usual) to the intervention every 3 months. Each hospital will be randomized to one of seven blocks. We aim to include 1200 patients. The primary outcome is the incidence of serious adverse events at 6 months. Secondary outcomes include (cost)effectiveness, functional outcome, and quality of life for up to 12 months. Discussion: PREPARATION is the first study to assess the effectiveness of a preoperative MDT meeting for high-risk noncardiac surgical patients in the presence of an anesthesiologist. If the results suggest that preoperative MDT discussions for high-risk patients are (cost)-effective, the current study facilitates implementation of preoperative MDT meetings in clinical practice. Trial registration: ClinicalTrials.gov NCT05703230. Registered on 11/09/2022. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
17456215
Volume :
24
Issue :
1
Database :
Academic Search Index
Journal :
Trials
Publication Type :
Academic Journal
Accession number :
172916038
Full Text :
https://doi.org/10.1186/s13063-023-07685-3