Mapping multicenter randomized controlled trials in anesthesiology: a scoping review

Abstract

Background Evidence suggests that there are substantial inconsistencies in the practice of anesthesia. There has not yet been a comprehensive summary of the anesthesia literature that can guide future knowledge translation interventions to move evidence into practice. As the first step toward identifying the most promising interventions for systematic implementation in anesthesia practice, this scoping review of multicentre RCTs aimed to explore and map the existing literature investigating perioperative anesthesia-related interventions and clinical patient outcomes. Methods Multicenter randomized controlled trials were eligible for inclusion if they involved a tested anesthesia-related intervention administered to adult surgical patients (≥\u200916\xa0years old), with a control group receiving either another anesthesia intervention or no intervention at all. The electronic databases Embase (via OVID), MEDLINE, and MEDLINE in Process (via OVID), and Cochrane Central Register of Control Trials (CENTRAL) were searched from inception to February 26, 2021. Studies were screened and data were extracted by pairs of independent reviewers in duplicate with disagreements resolved through consensus or a third reviewer. Data were summarized narratively. Results We included 638 multicentre randomized controlled trials ( n patients\u2009=\u2009615,907) that met the eligibility criteria. The most commonly identified anesthesia-related intervention theme across all studies was pharmacotherapy ( n studies\u2009=\u2009361 [56.6%]; n patients\u2009=\u2009244,610 [39.7%]), followed by anesthetic technique ( n studies\u2009=\u200980 [12.5%], n patients\u2009=\u200948,455 [7.9%]). Interventions were most often implemented intraoperatively ( n studies\u2009=\u2009233 [36.5%]; n patients\u2009=\u2009175,974 [28.6%]). Studies typically involved multiple types of surgeries ( n studies\u2009=\u2009187 [29.2%]; n patients\u2009=\u2009206 667 [33.5%]), followed by general surgery only ( n studies\u2009=\u2009115 [18.1%]; n patients\u2009=\u2009201,028 [32.6%]) and orthopedic surgery only ( n studies\u2009=\u200994 [14.7%]; n patients\u2009=\u200934,575 [5.6%]). Functional status was the most commonly investigated outcome ( n studies\u2009=\u2009272), followed by patient experience ( n studies\u2009=\u2009168), and mortality ( n studies\u2009=\u2009153). Conclusions This scoping review provides a map of multicenter RCTs in anesthesia which can be used to optimize future research endeavors in the field. Specifically, we have identified key knowledge gaps in anesthesia that require further systematic assessment, as well as areas where additional research would likely not add value. These findings provide the foundation for streamlining knowledge translation in anesthesia in order to reduce practice variation and enhance patient outcomes.