Impact of Multidisciplinary Team Meetings on Decision Making in Vascular Surgery: A Prospective Observational Study

Giorgio Prouse; Alessandro Robaldo; Jos C van den Berg; Ludovica Ettorre; Francesco Mongelli; Luca Giovannacci

doi:10.1016/j.ejvs.2023.03.037

Impact of Multidisciplinary Team Meetings on Decision Making in Vascular Surgery: A Prospective Observational Study

Eur J Vasc Endovasc Surg. 2023 Jul;66(1):130-135. doi: 10.1016/j.ejvs.2023.03.037. Epub 2023 Mar 25.

Authors

Giorgio Prouse¹, Alessandro Robaldo², Jos C van den Berg³, Ludovica Ettorre², Francesco Mongelli⁴, Luca Giovannacci²

Affiliations

¹ Service of Vascular Surgery, Ospedale Regionale di Lugano, Centro Vascolare Ticino, EOC, Lugano, Switzerland. Electronic address: giorgio.prouse@eoc.ch.
² Service of Vascular Surgery, Ospedale Regionale di Lugano, Centro Vascolare Ticino, EOC, Lugano, Switzerland.
³ Service of Interventional Radiology, Ospedale Regionale di Lugano, Centro Vascolare Ticino, EOC, Lugano, Switzerland; Inselspital Bern, Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie, Bern, Switzerland.
⁴ Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland; Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland.

PMID: 36972815
DOI: 10.1016/j.ejvs.2023.03.037

Abstract

Objective: This cohort study aimed to prospectively determine the impact of multidisciplinary team meetings (MDTs) on treatment plans in vascular patients.

Methods: The weekly MDT at the institution consisted of a structured discussion of vascular cases in the presence of at least one representative of each specialty from vascular surgery, angiology, and interventional radiology. Participants were asked to examine the cases entered on the digital MDT platform and to fill in forms with a detailed open text treatment recommendation for each patient. Individual recommendations were compared with the final MDT decision, which was based on a shared decision after discussion of clinical and radiological data. The primary endpoint was the agreement rate. The rate of decision implementation was determined to verify the adherence to MDT recommendations.

Results: Four hundred consecutive case discussions in 367 patients between November 2019 and March 2021 were included, excluding patients needing urgent treatment, yielding MDT discussion in 88.5% of carotid artery cases, 83% of aorto-iliac cases, and 51.7% of peripheral arterial cases, which included 56.9% of the chronic limb threatening ischaemia cases. The overall average agreement rate was 71% ± 41%. Analysis according to the specialty of the attending physician showed agreement rates of 82% ± 30% for senior vascular surgeons, 62% ± 44% for junior vascular surgeons, 71% ± 43% for interventional radiologists, 58% ± 50% for angiologists (p < .001), and 75% ± 38% considering only senior practitioners. The inter-rater agreement, resulted in kappa coefficients of 0.60 - 0.68 for senior vascular surgeons, 0.29 - 0.31 for junior vascular surgeons, 0.39 - 0.52 for interventional radiologists, and 0.25 for angiologists. The MDT treatment decision was implemented in 353 (96.2%) cases.

Conclusion: The impact of MDT discussion on treatment recommendations and the adherence to MDT recommendations were significant and in line with results reported from other specialties.

Keywords: Intervention; Multidisciplinary; Vascular.

Publication types

Observational Study

MeSH terms

Cohort Studies
Decision Making
Humans
Patient Care Team*
Specialties, Surgical*
Vascular Surgical Procedures