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

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.

Inclusion Criteria:18 years of age or older; andAmerican Society of Anesthesiology Physical Status (ASA-PS) score is 3 or more; andClinical Frailty Scale score is 4 or more; andPatient is planned for elective or semi-elective noncardiac surgery; andAs stated by the Dutch perioperative guideline:Doubt by the surgeon or anesthesiologist (or other discipline) regarding harm-benefit ratio of the surgical procedure; orDoubt if the correct measures were taken to limit the perioperative risk as much as possible; orDoubt if the patient agrees with the surgery or the anesthesiologic treatment and expected risks.Exclusion Criteria:no informed consentunable to communicate with patient (either directly or through third party)emergency surgeryProposed surgical intervention for which a structured preoperative multidisciplinary team meeting, similar to the current study intervention, already exists in this respective hospital at the start of the study