Perioperative Multidisciplinary Team Meetings: Illness Phases and Frailty in High‐Risk Surgical Candidates
Chuan‐Whei Lee, David Moore, Rohit D'Costa, Hannah Rotherham, Ned Douglas, Wen Kwang Lim, Jai DarvallABSTRACT
Background
Perioperative multidisciplinary team meetings consider surgical benefit for high‐risk candidates. We explored how illness phases were associated with meeting recommendations.
Methods
We conducted a retrospective cohort study of patients presented at our perioperative multidisciplinary team meetings between 2019 and 2022. Illness phases were defined using the modified surprise question: ‘even with surgery, would I be surprised if the patient dies in the next five years, twelve months, or one week?’ A ‘no’ response defined the ‘combined end‐of‐life’ phase, and ‘yes’ defined the ‘curative’ phase. The primary aim was to compare meeting recommendation to proceed to surgery between illness phases. Secondary aims included identifying predictors of meeting recommendation and whether patients underwent surgery.
Results
There were 175 cases in 164 patients presented. Nineteen percent ( n = 33) were assessed as ‘curative’ phase and 81% ( n = 142) as ‘combined end‐of‐life’ phase. Surgery was recommended in 38% of cases ( n = 66), with no difference between curative versus combined end‐of‐life illness phases (33% vs. 39%, OR [95% CI] 0.79 [0.32–1.86], p = 0.69). However, multivariable logistic regression demonstrated that combined end‐of‐life phase cases were more likely to be recommended for surgery (OR [95% CI] 3.53 [1.22–10.25], p = 0.02). Patients with moderate to severe frailty were less likely to be either recommended for surgery (OR [95% CI] 0.15 [0.03–0.63], p = 0.005) or undergo surgery (OR [95% CI] 0.22 [0.04–0.88], p = 0.03).
Conclusion
Illness phases were associated with meeting recommendations only on adjusted analysis, highlighting the need for further exploration. Frailty was the strongest predictor of both meeting recommendation and undergoing surgery.