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
Author:
Vernooij Jacqueline E. M.ORCID, 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, Timmerman Michel, Segers Zjuul, Schoester Dominique H. P. A. M., Vons Kristy M. J., Filius A., van Harten Wim, Poolman Rudolf W., Reijnen Michel M. P. J., Noordzij Peter G., van Munster Barbara C.,
Abstract
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.
Publisher
Springer Science and Business Media LLC
Subject
Pharmacology (medical),Medicine (miscellaneous)
Reference44 articles.
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