375 The Preoptimization of Multimorbid Patients Prior to Surgery

Abstract Aim Currently, there are no standardised preoperative care protocols that account for multimorbid patients or specific clusters of disease. This systematic review aims to (i) summarise the current state of the extent to which standardised preoperative protocols apply to multimorbid patients, (ii) investigate protocol compliance, and (iii) provide recommendations. Method This systematic review investigated the current preoperative care approaches used in a worldwide array of multimorbid patient cohorts within five electronic databases. Primary data, including 30-day outcomes, readmission and reoperation rates, and overall complications were extracted. Every identified study underwent quality appraisal. Results Out of 3,376 studies reviewed, 25 papers were identified for analysis. The identified papers represented a worldwide population of multi and single-centre cohorts of mostly older patients. Across the identified studies, approximately 2342191(42%) patients were multimorbid. Six out of 25 (24%) papers reported on specific pre-surgical protocols for multimorbid patients. Two papers centred their preoperative care around holistic care for patients. Three papers used a risk score - Qualifying Comorbidity Sets (QCS) - and one paper utilised their own propensity score. The data suggests that a consistent propensity score is emerging (QCS), however, there remains no standardised holistic care protocols. Conclusions In consideration of paucity of data, more extensive research is recommended of multimorbid cohorts using a preoperative protocol geared towards multimorbid patients. Specific recommendations include the implementation of a standardised risk stratification score for multimorbid surgical patients as well as the development of a standardised set of preoperative protocol(s) for optimization of multimorbid patient outcomes.