The association between preoperative multidisciplinary team care and patient outcome in frail patients undergoing cardiac surgery

Objective: To evaluate the in fl uence of preoperative multidisciplinary team (MDT) care on perioperative management and outcomes of frail patients undergoing cardiac surgery. Background: Frail patients are at increased risk for complications and functional outcome after cardiac surgery. In these patients, preoperative care may improve outcomes. Methods: Between 2018 and 2021,1168 patients aged 70 years or older were scheduled for cardiac surgery, of whom 98 (8.4 % ) frail patients were referred for care. The MDT discussed surgical risk, prehabilitation, and alternative treatment. Outcomes of MDT patients were compared with 183 frail patients (non-MDT group) from a historical study cohort (2015-2017). Inverse probability of treatment weighting was used to minimize bias from nonrandom allocation of MDT versus non-MDT care. Outcomes were severe postoperative complications, total days hospital after 120 days, disability, and health-related quality of life after 120 days. Results: This study included 281 patients (98 MDT and 183 non-MDT patients). the MDT patients, 67 (68 % ) had open surgery, 21 (21 % ) underwent minimally invasive procedures, and 10 (10 % ) received conservative treatment. In non-MDT group, all patients had open surgery. Fourteen (14 % ) MDT patients experienced a severe complication versus 42 (23 % ) non-MDT patients (adjusted relative risk, 0.76; 95 % CI, 0.51-0.99). Adjusted total days in hospital 120 days was 8 days (interquartile range, 3-12 days) versus 11 days (interquartile range, 7-16 days) for MDT and non-MDT patients, respectively ( P 1 / 4 .01). was no difference in disability or health-related quality of life. Conclusions: Preoperative MDT care for frail patients undergoing cardiac surgery is associated with alterations in surgical management and with a lower risk severe complications. (J Thorac Cardiovasc Surg 2024;168:608-16)