Abstract
BackgroundSurgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee.MethodsIn this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018.ResultsA total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported.ConclusionsGiven that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.
Highlights
Surgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes
Data collection We retrospectively investigated proceedings, which were managed by the Patient Safety Committee, and patient medical records associated with High-Risk Conferences held from April 2010 to March 2018
It was often necessary to evaluate whether a patient with severe cardiovascular or pulmonary comorbidities would be exposed to an unacceptable risk of serious perioperative complications after highly difficult surgery
Summary
Surgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. Surgical procedures have become more sophisticated and complex as a result of advances in medical technology [1]. Invasive surgery is more common [1, 2], and indications for surgery have expanded to include the elderly and patients with severe medical comorbidities [3, 4]. Surgeons need to consider medical as well as these nonmedical issues when developing an optimal treatment plan. This can be difficult to accomplish independently
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