Effect of Telemedicine Support for Intraoperative Anaesthesia Care on Postoperative Outcomes: The TECTONICS Randomised Clinical Trial

Abstract

Background: Novel applications of telemedicine can improve care quality and patient outcomes. Telemedicine for intraoperative decision support has not been rigorously studied.

Methods: This single centre randomised clinical trial (RCT, clinicaltrials.gov NCT03923699 ) of unselected adult surgical patients was conducted between 2019-07-01 and 2023-01-31. Patients received usual-care or decision support from a telemedicine service, the Anesthesiology Control Tower (ACT). The ACT provided real-time recommendations to intraoperative anaesthesia clinicians based on case reviews and physiologic alerts. ORs were randomised 1:1. Co-primary outcomes of 30-day all-cause mortality, respiratory failure, acute kidney injury (AKI), and delirium in the Intensive Care Unit (ICU) were analysed as intention-to-treat.

Results: The trial completed with 71927 surgeries (35302 ACT; 36625 usual care). The ACT performed 11812 case reviews and communicated alerts regarding 2044 intervention-group patients. There was no significant effect of the ACT vs. usual care on 30-day mortality [630/35302 (1.8%) vs 649/36625 (1.8%), RR 1.01 (95% CI 0.87 to 1.16), p=0.98], respiratory failure [1071/33996 (3.2%) vs 1130/35236 (3.2%), RR 0.98 (95% CI 0.88 to 1.09), p=0.98], AKI [2316/33251 (7.0%) vs 2432/34441 (7.1%), RR 0.99 (95% CI 0.92 to 1.06), p=0.98] or delirium [1264/3873 (32.6%) vs 1298/4044 (32.1%), RR 1.02 (95% CI 0.94 to 1.10), p=0.98]. There were no significant differences in secondary outcomes or sensitivity analyses.

Conclusions: In this large RCT of intraoperative telemedicine decision support using real-time alerts and case reviews, we found no significant differences in postoperative outcomes. Large-scale intraoperative telemedicine is feasible, and we suggest avenues where it may be more impactful.