{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T12:34:54Z","timestamp":1768566894992,"version":"3.49.0"},"posted":{"date-parts":[[2024,5,23]]},"group-title":"Anesthesia","reference-count":29,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T00:00:00Z","timestamp":1716422400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2024,11,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Novel applications of telemedicine can improve care quality and patient outcomes. Telemedicine for intraoperative decision support has not been rigorously studied.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    This single centre randomised clinical trial (RCT,\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/clinicaltrials.gov\">clinicaltrials.gov<\/jats:ext-link>\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT03923699\">NCT03923699<\/jats:ext-link>\n                    ) 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.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2024.05.21.24307593","type":"posted-content","created":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T02:26:04Z","timestamp":1716517564000},"source":"Crossref","is-referenced-by-count":0,"title":["Effect of Telemedicine Support for Intraoperative Anaesthesia Care on Postoperative Outcomes: The TECTONICS Randomised Clinical Trial"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4574-8616","authenticated-orcid":false,"given":"Christopher R","family":"King","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7239-8877","authenticated-orcid":false,"given":"Bradley A.","family":"Fritz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen 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