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

Trials

Study Protocol

Carmen D. Dirksen¹  Benedikt Preckel²  Nick J. Koning³  Jacqueline E. M. Vernooij⁴  Romijn M. Boerlage⁵  Cor J. Kalkman⁶  Rutger J. Spruit⁷  Carine J. M. Doggen⁸  Barbara L. van Leeuwen⁹  Hanneke van der Wal-Huisman⁹  Jean P. van Basten^1,10  Suzanne Festen^1,11 

[1] Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands;Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam Public Health, Quality of Care, Amsterdam Cardiovascular Science, Diabetes & Metabolism, Amsterdam, The Netherlands;Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands;Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands;Department of Anesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands;Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands;Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschedé, The Netherlands;Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands;Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam Public Health, Quality of Care, Amsterdam Cardiovascular Science, Diabetes & Metabolism, Amsterdam, The Netherlands;Department of Anesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands;Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschedé, The Netherlands;Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands;Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands;University Center for Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands;

关键词: Preoperative multidisciplinary team;    High-risk;    Complications;    Costs;    Quality of life;    Risk tools;    Frailty;    Mortality;    Patient’s preferences;    Serious adverse events;    Stepped-wedge randomized cluster design;    Cost-effectiveness;    Health technology assessment;   

DOI  :  10.1186/s13063-023-07685-3

 received in 2023-08-14, accepted in 2023-09-28,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAs 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/designPREPARATION 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.DiscussionPREPARATION 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 registrationClinicalTrials.gov NCT05703230. Registered on 11/09/2022.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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