Table 1 Multidisciplinary team (MDT) perioperative management protocol and key performance Indicators.
Phase | Discipline | Core Responsibilities & Optimization Goals | Specific Interventions & Recorded Metrics |
|---|---|---|---|
Preoperative Assessment & Optimization | Geriatrics | Perform a Comprehensive Geriatric Assessment (CGA) to evaluate frailty, nutrition, cognition, and medication use, identifying potential risks. | 1. Record the Clinical Frailty Scale (CFS) and Charlson Comorbidity Index (CCI) as baselines. 2. Record the number (n) and percentage (%) of patients who received interventions (e.g., nutritional support, cognitive assessment) based on CGA findings. |
Cardiology | Assess cardiac function, optimize cardiovascular medications to ensure the patient can best tolerate surgical stress. | 1. Clearance Criteria: Preoperative blood pressure controlled to < 150/90 mmHg, resting heart rate < 100 bpm. 2. Record the number (n) of patients whose medication regimen was adjusted due to cardiac insufficiency. | |
Pulmonology | Assess pulmonary function, instruct on breathing exercises to prevent postoperative pulmonary infections and respiratory failure. | 1. Clearance Criteria: Preoperative SpO₂ >92% in patients with moderate-to-severe COPD. 2. Record the number (n) of patients who received preoperative respiratory training (e.g., incentive spirometry). | |
Endocrinology | Establish strict perioperative glycemic control targets to avoid hypo- or hyperglycemic events. | 1. Optimization Goal: Preoperative fasting blood glucose < 8.0 mmol/L, postoperative blood glucose maintained at 8–10 mmol/L. 2. Record the number (n) of patients whose hypoglycemic regimen was adjusted due to poor glycemic control. | |
MDT Consensus | Integrate assessments from all disciplines for a joint decision on surgical timing and feasibility. | Record the number (n) of patients deemed unsuitable for surgery or requiring delay after MDT assessment and the primary reasons. | |
Intraoperative Management | Anesthesiology | Perform monitored anesthesia care (MAC), ensuring the patient is sedated, pain-free, and safe, and providing feedback to the surgeon. | 1. Record the number of instances where additional sedation/analgesia was required due to patient pain or discomfort. 2. Record the number of instances where intraoperative vital sign fluctuations exceeded preset limits (e.g., MAP fluctuation > 20% from baseline) and the management measures taken. |
Spine Surgery | Maintain continuous communication with the patient to minimize nerve injury risk and adjust intraoperative maneuvers. | Record the number of instances where the working channel or instrument position was adjusted in response to patient feedback (e.g., radicular pain). | |
Postoperative Enhanced Recovery | All MDT Members | Prevent complications, promote early functional recovery, and shorten hospital stay. | 1. Record the Time to First Ambulation (hours). 2. Record the Length of Postoperative Stay (days). 3. Record the number (n) of patients and types of new or worsened medical complications (e.g., delirium, heart failure, pneumonia). 4. Record the number of consultations requested from relevant departments for postoperative medical issues. |
