Objective

Increasing comorbidity, resection rates and changes in local protocols have resulted in more of our lung cancer patients requiring critical care admission and some undergoing prehabilitation. We established a weekly multi-disciplinary team (MDT) meeting to: • Facilitate meticulous and timely planning of the peri-operative journey for our high-risk patients. • Provide a robust system of communication within the MDT and with waiting-list coordinators.

Methods

The high-risk MDT was instituted in May 2015. It is led by a consultant thoracic anaesthetist with expertise in pre-operative assessment. Core members include one or more consultant thoracic surgeons, anaesthetists, clinical nurse specialists, cancer and waiting list coordinators. Eligibility criteria for discussion include: -Surgical/anaesthetic request -Bilobectomy/Pneumonectomy -PPO FEV1<40%, PPODLCO<40% -Intermediate/high risk CPET -Prehabilitation -Other critical care requirement

Results

56 patients were discussed at the thoracic high-risk MDT meeting during a pilot period of 17 weeks from May-September 2015. -Mean number patients discussed=3/week (range=1-5). -Median number of consultant thoracic surgeons present=1/week (range=1-3). -Median number of consultant thoracic anaesthetists present=2/week (range=1-3). See results tables 1 and 2 attached: 'Triggers for discussion' and 'Outcomes of patient discussion.'

Conclusion

We have demonstrated that the high-risk MDT meeting is feasible. It was easy to implement within our existing system of pre-operative assessment. Management plans for 75% of patients changed following discussion at the meeting. 9% of patients did not require critical care admission, though this had previously been requested. This represents a potential cost saving and may impact on theatre efficiency and late cancellations. The meeting has facilitated efficient and effective MDT communication.