Authors: Sachin Kheterpal, M.D., M.B.A. et al
Anesthesiology 2 2018, Vol.128, 272-282.
Background: The authors hypothesized that a multiparameter intraoperative decision support system with real-time visualizations may improve processes of care and outcomes.
Methods: Electronic health record data were retrospectively compared over a 6-yr period across three groups: experimental cases, in which the decision support system was used for 75% or more of the case at sole discretion of the providers; parallel controls (system used 74% or less); and historical controls before system implementation. Inclusion criteria were adults under general anesthesia, advanced medical disease, case duration of 60 min or longer, and length of stay of two days or more. The process measures were avoidance of intraoperative hypotension, ventilator tidal volume greater than 10 ml/kg, and crystalloid administration (ml • kg–1 • h–1). The secondary outcome measures were myocardial injury, acute kidney injury, mortality, length of hospital stay, and encounter charges.
Results: A total of 26,769 patients were evaluated: 7,954 experimental cases, 10,933 parallel controls, and 7,882 historical controls. Comparing experimental cases to parallel controls with propensity score adjustment, the data demonstrated the following medians, interquartile ranges, and effect sizes: hypotension 1 (0 to 5) versus 1 (0 to 5) min, P < 0.001, beta = –0.19; crystalloid administration 5.88 ml • kg–1 • h–1 (4.18 to 8.18) versus 6.17 (4.32 to 8.79), P < 0.001, beta = –0.03; tidal volume greater than 10 ml/kg 28% versus 37%, P < 0.001, adjusted odds ratio 0.65 (0.53 to 0.80); encounter charges $65,770 ($41,237 to $123,869) versus $69,373 ($42,101 to $132,817), P < 0.001, beta = –0.003. The secondary clinical outcome measures were not significantly affected.
Conclusions: The use of an intraoperative decision support system was associated with improved process measures, but not postoperative clinical outcomes.
What We Know about This Topic
• The extent to which intraoperative decision support systems guide care and improve outcomes remains unclear.
• The authors compared a novel decision support system to a historical control group and to a matched (nonrandomized) contemporaneous control group.
What This Article Tells Us That Is New
• Most improvements were time-dependent. Decision support was associated with improved process-of-care measures compared to contemporaneous control patients, but not with improved clinical outcomes.
• Decision support systems should be formally evaluated because the extent to which they will enhance patient care is not obvious.