Outcomes of clinical decision support systems in real-world perioperative care: a systematic review and meta-analysis.

BACKGROUND

Although clinical decision support systems (CDSS) have been developed to enhance the quality and efficiency of surgeries, little is known regarding the practical effects in real-world perioperative care.

OBJECTIVE

To systematically review and meta-analyze the current impact of CDSS on various aspects of perioperative care, providing evidence support for future research on CDSS development and clinical implementation.

METHODS

This systematic review and meta-analysis followed the Cochrane Handbook and PRISMA statement guidelines, searching databases up to 2 February 2024, including MEDLINE, PubMed, Embase, Cochrane, and Web of Science. It included studies on the effectiveness of CDSS in assisting perioperative decision-making, involving anesthesiologists, doctors, or surgical patients, and reporting at least one outcome such as complications, mortality, length of stay, compliance, or cost.

RESULTS

Forty studies met inclusion criteria, analyzing outcomes from 408 357 participants, predominantly in developed countries. Most perioperative CDSS use was associated with improved guideline adherence, decreased medication errors, and some improvements in patient safety measures such as reduced postoperative nausea and vomiting and myocardial injury. However, reported results varied widely, and no significant improvement in postoperative mortality was observed.

CONCLUSION

The preliminary findings of this review offer an overview of the potential use of CDSS in real-world perioperative situations to enhance patient and anesthesiologist outcomes, but further researches with broader outcome dimensions, involving more stakeholders, and with longer follow-up periods are warranted for the critical evaluation of CDSS and then in better facilitate clinical adoption.