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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (1): 185-191. doi: 10.19723/j.issn.1671-167X.2025.01.028

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Clinical application of multidisciplinary team in the diagnosis and treatment of chronic refractory wounds

Liwei WANG1, Bingchuan LIU2, Yinyin QU1, Changyi WU1, Yun TIAN2,*()   

  1. 1. Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
  • Received:2024-06-21 Online:2025-02-18 Published:2025-01-25
  • Contact: Yun TIAN E-mail:tiany@bjmu.edu.com
  • Supported by:
    the National Natural Science Foundation of China(82201337)

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Abstract:

Objective: To explore the application effectiveness of multidisciplinary team (MDT) in the diagnosis and treatment of chronic refractory wounds, and to provide new ideas for optimizing the clinical diagnosis and treatment of such diseases. Methods: A retrospective analysis was performed on the clinical data of patients with chronic refractory wounds who underwent surgery at Peking University Third Hospital from January 2015 to October 2023, and a total of 456 patients, including 290 males and 166 females, with an average age of (49.4±16.9) years. According to whether preoperative MDT discussion was conducted, the patients were divided into MDT discussion group and non-MDT discussion group. The overall implementation process of MDT included: Starting and recording with the medical office, collecting data and discussing the initial MDT, informing the patient of the treatment plan and strictly implementing it, and the change of the condition needs to be discussed again by MDT. The general clinical data, anesthesia risk grade, complications (hypertension, diabetes, coronary heart disease), and the etiology and location of chronic refractory wounds between the two groups were compared. The main observational measurements and outcome indicators of treatment effectiveness included the number of surgeries required to achieve wound healing after admission, the recurrence rate after wound healing, the incidence of perioperative complications (pulmonary infection, severe cardiovascular event, vein thrombus embo-lism, cerebral stroke and delirium, etc.), and patient satisfaction score. Results: There were 189 patients in the MDT discussion group and 267 patients in the non-MDT discussion group. There was no significant statistical difference in the clinical data, such as age, gender, body mass index, American Society of Anesthesiologists, comorbidities, etiology, and location of chronic refractory wounds between the two groups (P>0.05). The average number of surgeries required for wound healing in MDT discussion group and non-MDT discussion group was 2.1±1.1 and 2.8±1.6, respectively, with a statistically significant difference (P < 0.001). This difference was also significant in chronic refractory wounds caused by three etiologies: Diabetic ulcer, infection after trauma or surgery, and non-union after radiotherapy (P < 0.05). The recurrence rate of the patients in the non-MDT discussion group after wound healing was 18.0%, slightly higher than that in the MDT discussion group of 14.3% (P>0.05). In terms of perioperative complications, the non-MDT discussion group also had a higher incidence (3.7% vs. 2.6%), but the difference was not statistically significant (P>0.05). In terms of patient satisfaction, the MDT discussion group scored significantly higher (96.5 vs. 91.1, P=0.028). Conclusion: The MDT mode can significantly reduce the number of surgeries for patients with chronic refractory wounds, improve the effectiveness of therapy and increase patient satisfaction. It is a recommended model for optimizing the clinical diagnosis and treatment effectiveness of chronic refractory wounds.

Key words: Chronic refractory wounds, Multidisciplinary team, Number of surgeries, Complications

CLC Number: 

  • R632

Table 1

Comparison of clinical characteristics between the two groups"

Items MDT group (n=189) Non-MDT group (n=267) t/χ2/Z P
Age/years, ${\bar x}$±s 49.4±16.1 49.4±17.6 0.058 0.954
Gender, n (%)     1.806 0.179
    Male 127 (67.2) 163 (61.0)    
    Female 62 (32.8) 104 (39.0)    
BMI/(kg/m2)，${\bar x}$±s 24.6±3.5 23.9±2.8 0.122 0.629
ASA, n (%)     -0.663 0.507
    Ⅰ 22 (11.6) 35 (13.1)    
    Ⅱ 55 (29.1) 79 (29.6)    
    Ⅲ 82 (43.4) 117 (43.8)    
    Ⅳ 30 (15.9) 36 (13.5)    
Complication, n (%)     0.479 0.787
    Hypertension 18 (9.5) 26 (9.7)    
    Diabetes 65 (34.4) 88 (33.0)    
    Coronary heart disease 5 (2.7) 10 (3.7)    
    None 101 (53.4) 143 (53.6)    
Etiology of chronic refractory wounds, n (%)     5.051 0.282
    Pressure injuries 29 (15.3) 44 (16.5)    
    Diabetic ulcers 49 (25.9) 51 (19.1)    
    Nonunion after trauma or surgery 53 (28.0) 68 (25.5)    
    Infection after trauma or surgery 34 (18.0) 57 (21.3)    
    Nonunion after radiotherapy 24 (12.8) 47 (17.6)    
Sites of chronic refractory wounds, n (%)     2.453 0.484
    Head and neck 14 (7.4) 28 (10.5)    
    Chest or abdomen 38 (20.1) 45 (16.8)    
    Chest or abdomen 36 (19.1) 59 (22.1)    
    Limbs 101 (53.4) 135 (50.6)    

Table 2

Comparison of observation and outcome indicators between the two groups"

Items MDT group (n=189) Non-MDT group (n=267) t/χ2/Z P
Number of operations, ${\bar x}$±s 2.1±1.1 2.8±1.6 -5.276 < 0.001
Number of pressure injuries, ${\bar x}$±s 1.7±0.6 2.0±0.8 -1.908 0.060
Number of diabetic ulcers, ${\bar x}$±s 1.9±0.8 2.5±1.2 -2.885 0.005
Number of nonunion after trauma or surgery, ${\bar x}$±s 1.6±0.6 1.8±0.8 -1.261 0.210
Number of infection after trauma or surgery, ${\bar x}$±s 2.9±1.7 4.1±1.9 -2.738 0.007
Number of nonunion after radiotherapy, ${\bar x}$±s 2.7±0.9 3.3±1.1 -2.397 0.019
Total number of recurrences of refractory wounds, n (%) 27 (14.3) 48 (18.0) 1.098 0.295
Recurrence after wounds healing of different etiology, n (%)     0.593 0.964
    Pressure injuries 3 (1.6) 6 (1.1)    
    Diabetic ulcers 6 (3.2) 10 (3.7)    
    Nonunion after trauma or surgery 2 (1.1) 5 (1.9)    
    Infection after trauma or surgery 8 (4.2) 16 (6.0)    
    Nonunion after radiotherapy 8 (4.2) 11 (4.1)    
Recurrence after wound healing in different sites, n (%)     1.695 0.638
    Head and neck 1 (0.5) 3 (1.1)    
    Chest or abdomen 3 (1.6) 7 (2.6)    
    Waist or back 7 (3.7) 17 (6.4)    
    Limbs 16 (8.5) 21 (7.9)    
Total number of perioperative complications, n (%) 5 (2.6) 10 (3.7) 0.421 0.517
Perioperative complications, n (%)     0.592 0.898
    Pulmonary infection 1 (0.5) 3 (1.1)   0.645a
    Deep vein thrombosis 3 (1.6) 5 (1.9)   ＞0.999a
    Cerebrovascular accident 0 (0.0) 0 (0.0)    
    Delirium 1 (0.5) 2 (0.7)   ＞0.999a
Score of patient satisfaction, ${\bar x}$±s 96.5±7.1 91.1±4.9 2.186 0.028
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