Telemedicine Notifications With Machine Learning for Postoperative Care

Telemedicine Notifications With Machine Learning for Postoperative Care

The ODIN-Report study will be a randomized controlled trial of the effect of providing machine learning risk forecasts to providers caring for patients immediately after surgery on serious complications. The complications studied will be ICU admission or death on wards, acute kidney injury, and hospital length of stay.

This will be a single center, randomized, controlled, pragmatic clinical trial. The investigators will screen surgical patients enrolled in TECTONICS (NCT03923699) and randomized to intraoperative contact. Near the end of the operation, the investigators will calculate the same machine learning risk forecasts of major complications as TECTONICS, and enroll patients if all of the following are true: (1) No ICU admission is intended (2) ML mortality risk forecast is in top 15% of historical PACU patients.

Patients will be randomized 1:1:1 to no contact, brief contact, and full contact. The postoperative provider (PACU physician, anesthesiologist, ward clinician) will be notified before arrival of the risk forecast in the contact groups, and in the full contact group an additional set of explanatory ML outputs will be provided. The intention-to-treat principle will be followed for all analyses.

Inclusion Criteria:

• Enrolled in TECTONICS Study (ID 201903026, NCT03923699), in OR randomized to contact
• workweek hours
• preoperative assessment completed
• estimated risk of mortality in top 15% of historical PACU patients

Exclusion Criteria:

• Not enrolled in TECTONICS Study
• Operating room randomized to non-contact in TECTONICS
• Planned ICU admission