Large randomised controlled trials (RCTs) are generally conducted across multiple centres. However, patient outcomes may be expected to differ between participating centres. Variability in patient outcomes between participating centres may impair the integrity and reliability of multicentre trial findings. Many clinicians believe that between-centre differences in multicentre RCTs represent a level of “background noise” that will reduce the chance of finding a statistically significant treatment effect.
The investigators will use data from several large multicentre RCTs conducted by the ANZCA Clinical Trials Network. Data collected in each trial will be used, to see if adjusting for trial centre ranking affects the primary findings of each trial. We will also combine key data (length of hospital stay and mortality rates) from all the trials and using this pooled data to look for any evidence of correlation between the ranking of trial centres by the incidence of perioperative complications overall, and their ranking by the trial treatment effect on that incidence. We will also conduct further analysis to see if these relationships are stronger for more complex or difficult trial interventions.
This extensive analysis will provide compelling evidence on the reliability of large multicentre trials to answer important clinical questions in anaesthesia and perioperative medicine, with equally important implications for research in other fields of medicine.
Professor Philip Peyton, Austin Health, Melbourne
Ms Vanessa Pac Soo, Centre for Epidemiology and Biostatistics, Melbourne
The project was awarded $A17,250 funding through the ANZCA research grants program for 2023.