سامانه همایش های دانشگاه آزاد اسلامی واحد نجف آباد

صفحه اصلی / اولین همایش بین المللی تحول خدمات سلامت: تلفیق مراقبت، درمان، بازتوانی و امیدبخشی

Preoperative Multidisciplinary Team Discussion and Postoperative Intensive Care Utilization After Colorectal Cancer Surgery: A Multicentre Real-World Cohort Study

نویسندگان :

PARISA SOLEIMANI¹

1- UNIVERSITY OF Bologna

کلمات کلیدی :

Quality of Health Care

چکیده :

Background: Multidisciplinary team (MDT) discussion may influence not only treatment selection but also perioperative care planning and use of critical-care resources. We evaluated the association between documented preoperative MDT discussion and postoperative intensive care unit (ICU) utilization after colorectal cancer surgery. Method: This secondary analysis used the Emilia-Romagna Surgical Colorectal Cancer Audit (ESCA). Of 5,067 subjects in the export, 4,850 underwent surgery and had known MDT status. The primary service-utilization outcomes were any postoperative ICU stay and unplanned ICU admission. Unplanned ICU was defined as an ICU stay documented as not scheduled; patients without an ICU stay were classified as having no unplanned ICU admission, while ICU stays with missing/unknown scheduled status were excluded from this outcome. Multivariable binomial regression adjusted for age, sex, ASA class, ECOG performance status, surgical urgency, treatment intent, distant metastasis, and preoperative cancer-related complications. Elective- and urgent-surgery sensitivity analyses were performed. Finding: Any postoperative ICU stay occurred in 591/3,678 (16.1%) patients with MDT discussion and 301/1,134 (26.5%) without MDT discussion (adjusted OR 0.52, 95% CI 0.42-0.63; P<0.001; complete-case n=4,589). Unplanned ICU admission occurred in 73/3,551 (2.1%) versus 88/1,090 (8.1%), respectively (adjusted OR 0.32, 95% CI 0.22-0.48; P<0.001; complete-case n=4,438). The association persisted in elective (aOR 0.33, 95% CI 0.21-0.52; P<0.001) and urgent surgery (aOR 0.28, 95% CI 0.11-0.74; P=0.010), with no evidence of interaction by urgency (P=0.610). Among ICU patients with known scheduling status, scheduled admission was more frequent after MDT discussion (84.3% versus 65.8%; adjusted OR 1.97, 95% CI 1.25-3.11; P=0.003). Conclusion: Documented preoperative MDT discussion was independently associated with lower postoperative ICU utilization, particularly fewer unplanned ICU admissions, and with a greater proportion of scheduled ICU admissions. These observational findings support a potential role for MDT-based care coordination in perioperative resource planning but do not establish causality.