Effect of telemedicine support for intraoperative anaesthesia care on postoperative outcomes: the TECTONICS randomised clinical trial.

IF 9.1 1区医学 Q1 ANESTHESIOLOGY

British journal of anaesthesia Pub Date : 2025-01-02 DOI:10.1016/j.bja.2024.11.017

Christopher R King, Bradley A Fritz, Stephen H Gregory, Thaddeus P Budelier, Arbi Ben Abdallah, Alex Kronzer, Daniel L Helsten, Brian Torres, Sherry L McKinnon, Sandhya Tripathi, Mohamed Abdelhack, Shreya Goswami, Arianna Montes de Oca, Divya Mehta, Miguel A Valdez, Evangelos Karanikolas, Omokhaye Higo, Paul Kerby, Bernadette Henrichs, Troy S Wildes, Mary C Politi, Joanna Abraham, Michael S Avidan, Thomas Kannampallil

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引用次数: 0

Abstract

Background: Telemedicine may help improve care quality and patient outcomes. Telemedicine for intraoperative decision support has not been rigorously studied.

Methods: This was a single-centre randomised clinical trial of unselected adult surgical patients. Patients were randomised to receive usual care or decision support from a telemedicine service, which provided real-time recommendations to intraoperative anaesthesia clinicians based on case reviews and physiological alerts. ORs were randomised 1:1. The co-primary outcomes were 30-day all-cause mortality, respiratory failure, acute kidney injury, and delirium in the intensive care unit, analysed by intention to treat.

Results: Between July 1, 2019, and January 31, 2023, a total of 35,302 patients were randomised to receive telemedicine support, with 36,625 receiving usual care. Telemedicine clinicians provided review in 11,812/35,302 cases, with alerts delivered to 2044/35,302 patients. Telemedicine support had no effect on any of the co-primary outcomes. Within 30 days, 630/35,302 (1.8%) patients randomised to telemedicine died within 30 days, compared with 649/36,625 (1.8%) receiving usual care (relative risk [RR]1.01, 95% confidence interval [CI] 0.87-1.16, P=0.98). Telemedicine support did not alter postoperative respiratory failure [telemedicine 1071/33,996 (3.2%) vs usual care 1130/35,236 (3.2%), RR 0.98, 95% CI 0.88-1.09, P=0.98], acute kidney injury [telemedicine 2316/33 251 (7.0%) vs usual care 2432/34,441 (7.1%); RR 0.99, 95% CI 0.92-1.06, P=0.98], or delirium [telemedicine 1264/3873 (32.6%) vs usual care 1298/4044 (32.1%), RR 1.02, 95% CI 0.94-1.10, P=0.98].

Conclusions: In this large randomised clinical trial, intraoperative telemedicine decision support using real-time alerts and case reviews had no impact on adverse postoperative outcomes.

Clinical trial registration: NCT03923699.

查看原文本刊更多论文

远程医疗支持术中麻醉护理对术后结局的影响：TECTONICS随机临床试验。

背景：远程医疗可能有助于提高护理质量和患者预后。远程医疗在术中决策支持方面的应用尚未得到严格的研究。方法：这是一项未选择的成人外科患者的单中心随机临床试验。患者被随机分配接受常规护理或远程医疗服务的决策支持，远程医疗服务根据病例回顾和生理警报向术中麻醉临床医生提供实时建议。or按1:1随机分组。共同主要结局是重症监护室的30天全因死亡率、呼吸衰竭、急性肾损伤和谵妄，并按治疗意向进行分析。结果：2019年7月1日至2023年1月31日期间，共有35302名患者随机接受远程医疗支持，其中36625名患者接受常规护理。远程医疗临床医生对11,812/35,302例病例进行了审查，并向2044/35,302例患者发出了警报。远程医疗支持对任何共同主要结果都没有影响。在30天内，随机接受远程医疗的患者中有630/35,302（1.8%）在30天内死亡，而接受常规护理的患者中有649/36,625（1.8%）死亡（相对风险[RR]1.01, 95%可信区间[CI] 0.87-1.16， P=0.98）。远程医疗支持未改变术后呼吸衰竭[远程医疗1071/33,996 (3.2%)vs常规护理1130/35,236 (3.2%),RR 0.98, 95% CI 0.88-1.09， P=0.98]，急性肾损伤[远程医疗2316/ 33251 (7.0%)vs常规护理2432/34,441 (7.1%)；RR 0.99, 95% CI 0.92-1.06， P=0.98]或谵妄[远程医疗1264/3873 (32.6%)vs常规护理1298/4044 (32.1%),RR 1.02, 95% CI 0.94-1.10， P=0.98]。结论：在这项大型随机临床试验中，使用实时警报和病例回顾的术中远程医疗决策支持对术后不良结果没有影响。临床试验注册：NCT03923699。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.