title: Is there a role for the high-risk multidisciplinary team meeting in thoracic surgery?
abstract: OBJECTIVE
  There is little information on the impact of a high-risk multidisciplinary team (HRMDT) for thoracic surgery. In our unit, patients considered high risk for thoracic surgery have been discussed at this meeting since its inception in June 2013. The aim of this study was to audit our selection of patients discussed at the HRMDT and its effect on patient outcomes.
  
  
  METHODS
  Data were prospectively collected on all patients (n = 820) who underwent lung resection for lung cancer between July 2013 and September 2014. Patients were analysed as two groups HRMDT versus non-HRMDT. Referral to the HRMDT was at the operating surgeons' discretion. Referred patients usually had a higher-than-expected mortality or morbidity risk for the indicated procedure. The median time from HRMDT to surgery was 27 days (IQR 27.75). The median follow-up for all patients was 415 days (IQR 240).
  
  
  RESULTS
  There were 102 patients in the HRMDT group and 718 in the non-HRMDT group (males 54 vs 46%; P = 0.12). The median duration from HRMDT to surgery was 27 days (IQR 27.75). Mean age (P = 0.0001), cardiac risk score (P = 0.001) and Thoracoscore (P = 0.0001) were significantly higher in the HRMDT group. There was also a significantly higher proportion of pneumonectomies in the HRMDT group (12 vs 4%; P = 0.001). There were no significant differences between the groups in cardiac, cerebrovascular, GI, pulmonary, renal or composite complications. There was no significant difference in 30-day (3 vs 1%; P = 0.24) or 90-day (5 vs 3%; P = 0.48) mortality between the groups. Operated HRMDT patients had better survival at 200 days (P = 0.002), but there was no difference in long-term survival compared with patients turned down for surgery.
  
  
  CONCLUSIONS
  Despite a higher predicted mortality rate by Thoracoscore, HRMDT patients had the same outcome as lower risk non-HRMDT patients. Within the HRMDT cohort, survival in the operated patients was significantly better than that in non-operated patients in the short term. The HRMDT has managed to offer patients a radical treatment option who might have been refused surgery prior to this due to their higher risk profile. We would recommend this forum as a means to further assess and discuss high-risk patients.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals of South Manchester, Manchester, UK.
authors.forename: Nnamdi
authors.initials: N
authors.lastname: Nwaejike
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals of South Manchester, Manchester, UK.
authors.forename: Ehab
authors.initials: E
authors.lastname: Elbur
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals of South Manchester, Manchester, UK.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Malagon
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals of South Manchester, Manchester, UK.
authors.forename: Natalie
authors.initials: N
authors.lastname: Dodman
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals of South Manchester, Manchester, UK.
authors.forename: Kath
authors.initials: K
authors.lastname: Hewitt
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals of South Manchester, Manchester, UK.
authors.forename: Eustace
authors.initials: E
authors.lastname: Fontaine
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals of South Manchester, Manchester, UK.
authors.forename: Piotr
authors.initials: P
authors.lastname: Krysiak
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals of South Manchester, Manchester, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Jones
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals of South Manchester, Manchester, UK.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Shah
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals of South Manchester, Manchester, UK kandadai.rammohan@uhsm.nhs.uk.
authors.forename: Kandadai S
authors.initials: KS
authors.lastname: Rammohan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010348:Patient Care Team; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Lung cancer; Oncology; Perioperative care; Surgery