Effects of Preoperative Multidisciplinary Team Meetings for High-risk, Adult, Noncardiac Surgical Patients

Summary

The current multicenter stepped wedge randomized cluster trial study aims to assess whether implementation of preoperative multidisciplinary team (MDT) discussions is (cost)effective for high risk noncardiac surgical patients.

The main questions to answer are:

* Primary question: Does implementation of preoperative multidisciplinary team discussions for high risk noncardiac surgical patients diminish serious adverse events as compared to care as usual at six months postoperatively or six months after multidisciplinary team discussion in case of nonsurgical treatment?
* Secondary questions: Does implementation of preoperative multidisciplinary team discussion for high risk noncardiac surgical patients improve disability, survival, functional outcome, quality of life and cost-effectiveness as compared to care as usual at six months postoperatively or six months after multidisciplinary team discussion in case of nonsurgical treatment?

Participants will be asked to answer questionnaires at baseline, 3, 6,9 and 12 months postoperatively or post MDT discussion.

Patients for whom no structured preoperative multidisciplinary discussion is installed yet (care as usual) will be compared with patients for whom a structured preoperative multidisciplinary discussion is performed (intervention).

The study will be performed in hospitals that have no established preoperative MDT meeting at the start of the study.

Conditions

• Interdisciplinary Communication
• Postoperative Complications
• Noncardiac Surgery
• Surgical Procedures, Operative
• Preoperative Care
• Patient Care Team
• Cost-Benefit Analysis
• Comorbidities and Coexisting Conditions

Interventions

OTHER

Structured preoperative multidisciplinary team meeting

The intervention to be investigated is the introduction of a preoperative structured multidisciplinary team (sMDT) meeting for high risk noncardiac surgical patients, which is attended by at least the treating surgical specialist, an anesthesiologist and another medical consultant with expertise relevant for the patients comorbidities and preferences. In the preoperative sMDT meeting, at least the following questions will be discussed as recommended by the Dutch Perioperative Guideline: * Is the proposed surgical intervention appropriate care for the patient? * Is the risk/benefit ratio of the proposed surgical intervention acceptable for the patient? * Should the patient's condition be optimized before undergoing the proposed surgical intervention?

Sponsors & Collaborators

• ZonMw: The Netherlands Organisation for Health Research and Development

  collaborator OTHER

• Amsterdam UMC

  collaborator OTHER

• University of Twente

  collaborator OTHER

• University Medical Center Groningen

  collaborator OTHER

• Maastricht University Medical Center

  collaborator OTHER

• Leiden University Medical Center

  collaborator OTHER

• Rijnstate Hospital

  lead OTHER

Principal Investigators

• Nick J. Koning, MD PhD DESA · Rijnstate Hospital

• Jacqueline E. Vernooij, MD, MA · Rijnstate Hospital

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

SEQUENTIAL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2022-11-01

Primary Completion

2026-12-31

Completion

2027-02-28

Countries

• Netherlands

Study Locations