Key result
Upcoming trial tests whether machine learning improves clinician accuracy in predicting postoperative death and AKI.
Why the study?
It is unknown whether anesthesiology clinicians in intraoperative telemedicine settings can predict postoperative complications more accurately when assisted by machine learning tools.
Does machine learning assistance improve the accuracy of anesthesiology clinicians in predicting postoperative death and acute kidney injury in adult surgical patients?
RCT (n=5,300)
Single-blind
1:1
No
Does machine learning assistance improve the accuracy of anesthesiology clinicians in predicting postoperative death and acute kidney injury in adult surgical patients?
This study protocol describes a randomized trial to evaluate whether machine learning assistance improves the accuracy of anesthesiology clinicians in predicting postoperative death and acute kidney injury.
Upcoming RCT will test ML assistance for anesthesiology prediction of death and AKI; extends AI evaluation to perioperative risk stratification.
<ns4:p> <ns4:bold>Background:</ns4:bold> More than four million people die each year in the month following surgery, and many more experience complications such as acute kidney injury. Some of these outcomes may be prevented through early identification of at-risk patients and through intraoperative risk mitigation. Telemedicine has revolutionized the way at-risk patients are identified in critical care, but intraoperative telemedicine services are not widely used in anesthesiology. Clinicians in telemedicine settings may assist with risk stratification and brainstorm risk mitigation strategies while clinicians in the operating room are busy performing other patient care tasks. Machine learning tools may help clinicians in telemedicine settings leverage the abundant electronic health data available in the perioperative period. The primary hypothesis for this study is that anesthesiology clinicians can predict postoperative complications more accurately with machine learning assistance than without machine learning assistance. </ns4:p> <ns4:p> <ns4:bold>Methods:</ns4:bold> This investigation is a sub-study nested within the TECTONICS randomized clinical trial (NCT03923699). As part of TECTONICS, study team members who are anesthesiology clinicians working in a telemedicine setting are currently reviewing ongoing surgical cases and documenting how likely they feel the patient is to experience 30-day in-hospital death or acute kidney injury. For patients who are included in this sub-study, these case reviews will be randomized to be performed with access to a display showing machine learning predictions for the postoperative complications or without access to the display. The accuracy of the predictions will be compared across these two groups. </ns4:p> <ns4:p> <ns4:bold>Conclusion:</ns4:bold> Successful completion of this study will help define the role of machine learning not only for intraoperative telemedicine, but for other risk assessment tasks before, during, and after surgery. </ns4:p> <ns4:p> <ns4:bold>Registration:</ns4:bold> ORACLE is registered on ClinicalTrials.gov: NCT05042804; registered September 13, 2021. </ns4:p>
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Fritz et al. (2022) conducted an RCT in Postoperative complications (death and acute kidney injury) (n=5,300). Machine learning (ML) assistance for predicting postoperative complications vs. No ML assistance (standard case review) was evaluated on Clinician accuracy in predicting postoperative death (30-day in-hospital mortality) and postoperative AKI (within 7 days), measured by AUC. As a study protocol, no clinical results are available yet, but the trial will evaluate whether machine learning assistance improves the accuracy of anesthesiology clinicians in predicting 30-day postoperative death and acute kidney injury.
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