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The Fragility of Statistically Significant Findings in Randomized Controlled Anaesthesiology Trials – a Systematic Review
SUPPLEMENTARY ONLINE CONTENT
Guido Mazzinari1, Lorenzo Ball2, Ary Serpa Neto3,4, Carlos L. Errando5,
Arjen M. Dondorp6, Lieuwe D. Bos4, Marcelo Gama de Abreu7,
Paolo Pelosi2, Marcus J. Schultz4,6
Hospital de Manises, Valencia, Spain
1Research Group in Perioperative Medicine Hospital Universitario y Politecnico La Fe, Valencia, Spain
Policlinico San Martino Hospital – IRCCS for Oncology, Genoa, Italy
2Department of Surgical Sciences and Integrated Diagnostics
Hospital Israelita Albert Einstein, São Paulo, Brazil
3Department of Critical Care Medicine
Academic Medical Center, Amsterdam, The Netherlands
4Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A)
Consorcio Hospital General Universitario de Valencia, Valencia, Spain
5Department of Anesthesiology, Resuscitation and Pain Treatment
Mahidol University, Bangkok, Thailand
6Mahidol Oxford Research Unit (MORU)
Technische Universität Dresden, Dresden, Germany
7Department of Anesthesiology and Intensive Care Therapy
eTable 1 – List of Journals
Anesthesiology
Impact Factor1
Chest
6.136
British Journal of Anaesthesia
5.616
Anesthesiology
5.264
Anesthesia & Analgesia
3.827
Anaesthesia
3.794
Regional Anesthesia and Pain Medicine
3.459
European Journal of Anaesthesiology
3.364
Journal of Neurosurgical Anesthesiology
2.828
Canadian Journal of Anaesthesia
2.139
Acta Anaesthesiologica Scandinavica
2.049
International Journal of Obstetric Anesthesia
2.040
Minerva Anestesiologica
2.036
Journal of Cardiothoracic and Vascular Anesthesia
1.519
Journal of Clinical Anesthesia
1.284
Anaesthesia and Intensive Care
1.283
General medicine
The New England Journal of Medicine
59.558
The Lancet
44.020
The Journal of American Medical Association
37.680
British Medical Journal
19.697
Annals of Internal Medicine
16.593
1 2015 Journal Citation Reports Impact Factor
PubMed full search criteria
(1991 : 2016[dp]) AND (((((((((((((((("dead"[Title/Abstract] OR "death"[Title/Abstract] OR "died"[Title/Abstract] OR "mortality"[Title/Abstract] OR "surviv*"[Title/Abstract]) OR "delirium"[Title/Abstract] OR "cognitive dysfunction"[Title/Abstract]) OR "myocardial ischemia"[Title/Abstract] OR "perioperative ischemia"[Title/Abstract]) OR "venous thrombosis"[Title/Abstract]) OR "pulmon*"[Title/Abstract]) OR "renal insufficiency"[Title/Abstract] OR "acute kidney injury"[Title/Abstract] OR "acute renal failure"[Title/Abstract]) OR "blood transfusion"[mh]) OR "postoperative complication"[Title/Abstract] OR "postoperative complications"[mh]) OR "postoperative residual curarization"[Title/Abstract] OR "postoperative residual paralysis"[Title/Abstract] OR "postoperative residual neuromuscular block"[Title/Abstract] OR "postoperative residual neuromuscular blockade"[Title/Abstract]) OR "delayed emergence from anesthesia"[mh]) OR "failed intubation"[Title/Abstract] OR "airway management"[mh] OR "intubation, intratracheal"[mh] OR "laryngeal Masks"[mh]) OR "injections, epidural"[mh] OR "injections, spinal"[mh] OR "anesthesia, conduction"[mh]) OR "perioperative care"[mh]) OR "hemodynamics"[mh]) OR "surgical wound infection"[mh]) OR "cesarean section"[Title/Abstract] OR "postpartum hemorrhage"[Title/Abstract] OR "eclampsia"[Title/Abstract] OR "preeclampsia"[Title/Abstract] OR "pre-eclampsia"[Title/Abstract] OR "hellp syndrome"[Title/Abstract] OR "neonatal mortality"[Title/Abstract] OR "anesthesia, obstetrical"[mh]) OR ("anesthesia and analgesia"[mh]) NOT (pediatric[Title/Abstract] OR children[Title/Abstract] OR infant*[Title/Abstract] OR neonate*[Title/Abstract] OR protocol[Title/Abstract] OR fetal[Title/Abstract] OR post hoc[Title/Abstract]) AND (english[Language]) AND (randomized controlled trial[Publication Type]).
eTable2 – GRADE1 rank of outcomes
Importance of outcomes
GRADE rank
Outcome (examples)
9
· Mortality
CRITICAL
Requiring major interventions, prolonged monitoring, or admission to ICU
8
· Organ failures, including major pulmonary complications, major cardiac events, kidney failure requiring RRT, delirium, need for inotropic drugs/vasopressors, severe stroke, pulmonary aspiration
7
· CP bypass weaning failure
· Mild stroke
· Pulmonary embolism
· Eclampsia/ HELLP syndrome
· Post ERCP Pancreatitis
IMPORTANT
Requiring simple interventions
6
· Surgical infection
· Cognitive dysfunction
· Transient perioperative hemodynamic instability requiring drug treatment
· Airway management faiure
5
· Deep Vein Thrombosis (DVT)
· Residual curarization
· Arrythmia
· Blood Transfusion
· Regional block related complications (Spinal failure, diaphragmatic paralysis)
4
· Surgical pain
· Postdural punction headache
LOW IMPORTANCE
Requiring no immediate actions
3
· Nausea
2
· Hoarseness
1
· Sore Throat
1 Grading of Recommendations Assessment, Development, and Evaluation.
Trials with outcomes of low importance were excluded from the analysis.
eTable3 – List of studies included in the analysis
Year
Journal
Title
Outcome
Analyzed
Number of patients
2016
Lancet
Routine pre-procedural rectal indometacin versus selective post-procedural rectal indometacin to prevent pancreatitis in patients undergoing endoscopic retrograde cholangiopancreatography: a multicentre, single-blinded, randomised controlled trial.
Post ERCP Pancreatitis
2600
2016
JAMA
Effect of Noninvasive Ventilation on Tracheal Reintubation Among Patients With Hypoxemic Respiratory Failure Following Abdominal Surgery. A Randomized Clinical Trial.
Reintubation
300
2016
BJA
Extrafascial injection for interscalene brachial plexus block reduces respiratory complications compared with a conventional intrafascial injection: a randomized, controlled, double-blind trial.
Diaphragmatic paralysis
40
2016
Lancet
Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial
Delirium
700
2016
BJA
The effects of thermal softening of double-lumen endobronchial tubes on postoperative sore throat, hoarseness and vocal cord injuries: a prospective double-blind randomized trial.
Vocal Cords Injury
140
2016
Anesthesiology
Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery. A Randomized Controlled Trial.
Delirium
185
2016
J Clin Anesth
Total intravenous anesthesia with propofol is associated with a lower rate of postoperative delirium in comparison with sevoflurane anesthesia in elderly patients
Delirium
59
2016
NEJM
Adjunctive Azithromycin Prophylaxis for Cesarean Delivery.
Infection
2013
2016
NEJM
A Randomized Trial Comparing Skin Antiseptic Agents at Cesarean Delivery.
Infection
1147
2015
Anesth Analg
Nicardipine is superior to esmolol for the management of postcraniotomy emergence hypertension: a randomized open-label study.
Hypertension Treatment
52
2015
Reg Anesth Pain Med
Hemidiaphragmatic paralysis following ultrasound-guided supraclavicular versus infraclavicular brachial plexus blockade: a randomized clinical trial.
Diaphragmatic paralysis
64
2015
Anaesthesia
Incidence of intravascular injection and the spread of contrast media during S1 transforaminal epidural steroid injection by two approaches: anteroposterior vs oblique
Vertebral IV Injection
208
2015
Anesthesiology
Effects of an Innovative Psychotherapy Program for Surgical Patients: Bridging Intervention in Anesthesiology--A Randomized Controlled Trial.
Psychological Followup
220
2015
JAMA
Effect of Remote Ischemic Preconditioning on Kidney Injury Among High-Risk Patients Undergoing Cardiac Surgery. A Randomized Clinical Trial
AKI
240
2015
Chest
A Double-Blind Placebo-Controlled Study of the Effects of Olprinone, a Specifi c PhosphodiesteraseIII Inhibitor, for Preventing Postoperative Atrial Fibrillation in Patients Undergoing Pulmonary Resection for Lung Cancer
Arrythmia
50
2015
Anesthesiology
Transfusion Requirements in Surgical Oncology Patients A Prospective, Randomized Controlled Trial
Mortality
198
2015
BJA
Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study
Postoperative Residual Curarization
154
2014
BJA
6% Hydroxyethyl starch (130/0.4) vs Ringer's lactate preloading before spinal anaesthesia for Caesarean delivery: the randomized, double-blind, multicentre CAESAR trial.
Hemodynamic
167
2014
JAMA
Colchicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation: the COPPS-2 randomized clinical trial.
Adverse Cardiac Outcome
360
2014
J Neurosurg Anestheiol
A comparison of the GlideScope with the Macintosh laryngoscope for nasotracheal intubation in patients with ankylosing spondylitis.
Airway success
60
2014
EJA
The effect of adjusting tracheal tube cuff pressure during deep hypothermic circulatory arrest. A randomised trial
Subglottic
Aspiration
24
2014
EJA
Reduction in the incidence of acute kidney injury after aortic arch surgery with low-dose atrial natriuretic peptide.A randomised controlled trial
AKI
50
2014
Anesthesiology
Restrictive Deferred Hydration Combined with Preemptive Norepinephrine Infusion during Radical Cystectomy Reduces Postoperative Complications and Hospitalization Time. A Randomized Clinical Trial
Composite
167
2014
Anaesthesia
Prophylactic vs therapeutic blood patch for obstetric patients with accidental dural puncture – a randomised controlled trial
Post Dural Punction Headache
116
2014
EJA
Comparison of Aintree and Fastrach techniques for low-skill fibreoptic intubation in patients at risk of secondary cervical injury. A randomised controlled trial
Airway Success
80
2014
BJA
Tracheal intubation in patients with odentogenous abscesses and reduced mouth opening
Airway Failure
100
2013
BJA
Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction
Delirium
1277
2013
NEJM
A Trial of Intraoperative Low-Tidal-Volume Ventilation in Abdominal Surgery
Composite
400
2013
J Cardiothorac Vasc Anesth
Morphine is a Reasonable Alternative to Haloperidol in the Treatment of Postoperative Hyperactive-Type Delirium After Cardiac Surgery
Delirium
53
2013
J Neurosurg Anesthesiol
BIS-guided Anesthesia Decreases Postoperative Delirium and Cognitive Decline
Cognitive Dysfunction
921
2012
Anesth Analg
Reduction in Intraoperative Bacterial Contamination of Peripheral Intravenous Tubing Through the Use of a Passive Catheter Care System
Bacterial Contamination
594
2012
Anesthesiology
Early Treatment with Risperidone for Subsyndromal Delirium after On-pump Cardiac Surgery in the Elderly. A Randomized Trial
Delirium
101
2012
Anesth Analg
Tranexamic Acid Reduces Blood Loss After Off-Pump Coronary Surgery: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study
Blood Transfusion
260
2012
Anesthesiology
Comparative effectiveness of the C-MAC video laryngoscope versus direct laryngoscopy in the setting of the predicted difficult airway
Airway Success
300
2012
Anesthesiology
Association between the apolipoprotein E4 and postoperative cognitive dysfunction in elderly patients undergoing intravenous anesthesia and inhalation anesthesia
Cognitive dysfunction
2000
2011
Anesthesiology
Effect of single recombinant human erythropoietin injection on transfusion requirements in preoperatively anemic patients undergoing valvular heart surgery
Blood transfusion
74
2011
Anesthesiology
Intraoperative acceleromyography monitoring reduces symptoms of muscle weakness and improves quality of recovery in the early postoperative period
Curarization
155
2011
Anesthesiology
Ultrasound imaging facilitates spinal anesthesia in adults with difficult surface anatomic landmarks
Spinal anesthesia success
145
2011
EJA
Effect of auditory evoked potential-guided anaesthesia on consumption of anaesthetics and early postoperative cognitive dysfunction: a randomised controlled trial
Cognitive dysfunction
451
2011
Acta Anaesthesiol Scand
Intraoperative warming and post-operative cognitive dysfunction after total knee replacement
Cognitive Dysfunction
150
2011
EJA
The influence of residual neuromuscular block on the incidence of critical respiratory events. A randomised, prospective, placebo-controlled trial
Pulmonary
114
2011
JAMA
Hydrocortisone therapy for patients with multiple trauma: the randomized controlled HYPOLYTE study
Pulmonary
150
2011
Anaesthesia
The influence of propofol or desflurane on postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery
Cognitive dysfunction
182
2011
J Neurosurg Anesth
Deeper total intravenous anesthesia reduced the incidence of early postoperative cognitive dysfunction after microvascular decompression for facial spasm
Cognitive dysfunction
96
2010
Anesthesiology
Comparison of Single-use and Reusable Metal Laryngoscope Blades for Orotracheal Intubation during Rapid Sequence Induction of Anesthesia
Airway Failure
1072
2010
Anesthesiology
Perioperative Intravenous Amiodarone Does Not Reduce the Burden of Atrial Fibrillation in Patients Undergoing Cardiac Valvular Surgery
Arrythmia
120
2010
NEJM
Preventing surgical-site infections in nasal carriers of Staphylococcus aureus
Infection
918
2010
NEJM
Apixaban versus Enoxaparin for Thromboprophylaxis after Hip Replacement
Composite
5407
2010
Anesthesiology
Cosyntropin for prophylaxis against postdural puncture headache after accidental dural puncture
Postdural Puncttion Headache
95
2010
Lancet
Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial.
Mortality
20211
2010
JAMA
Effect of a lung protective strategy for organ donors on eligibility and availability of lungs for transplantation: a randomized controlled trial
Lung transplant validity
118
2009
Minerva Anestesiol
Training resident anesthesiologists in adult challenging intubation comparing
Truview EVO2™ and Macintosh laryngoscope: a preliminary study
Airway Failure
30
2009
JAMA
Effects of Donor Pretreatment With Dopamine on Graft Function After Kidney Transplantation. A Randomized Controlled Trial
Dyalisis
505
2009
Chest
Prophylactic Nasal Continuous Positive Airway Pressure Following Cardiac
Surgery Protects From Postoperative Pulmonary Complications A Prospective, Randomized, Controlled Trial in 500 Patients
Pulmonary
500
2009
Anesthesiology
Continuous Perioperative Insulin Infusion Decreases Major Cardiovascular Events in Patients Undergoing Vascular Surgery. A Prospective, Randomized Trial
Composite
242
2009
Anesthesiology
Safety and Efficacy of Intensive Insulin Therapy in Critical Neurosurgical Patients
Hypoglucemia
483
2009
J Cardiothorac Vasc Anesth
Ketamine Attenuates Delirium After Cardiac Surgery With
Cardiopulmonary Bypass
Delirium
58
2009
EJA
Retrograde autologous priming of the cardiopulmonary bypass circuit reduces blood transfusion in small adults: a prospective, randomized trial
Blood Transfusion
120
2009
Acta Anaesthesiol Scand
Ketamine attenuates post-operative cognitive dysfunction after cardiac surgery
Cognitive dysfunction
52
2009
BMJ
Does single application of topical chloramphenicol to high risk sutured wounds reduce incidence of wound infection after minor surgery? Prospective randomised placebo controlled double blind trial
Infection
1014
2008
Anesth Analg
Tranexamic Acid and Aprotinin in Primary Cardiac Operations: An Analysis of 220 Cardiac Surgical Patients Treated with Tranexamic Acid or Aprotinin
Blood Transfusion
220
2008
Anesthesiology
Success of Tracheal Intubation with Intubating Laryngeal Mask Airways A Randomized Trial of the LMA Fastrach™ and LMA CTrach™
Airway success
271
2008
BJA
Tracheal intubation of morbidly obese patients: a randomized trial comparing performance of Macintosh and Airtraq laryngoscopes
Airway Failure
106
2008
Lancet
Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial
Composite
9298
2008
Anesthesiology
Intraoperative acceleromyographic monitoring reduces the risk of residual neuromuscular blockade and adverse respiratory events in the postanesthesia care unit
Curarization
185
2008
BJA
Pentax-AWS, a new videolaryngoscope, is more effective than the Macintosh laryngoscope for tracheal intubation in patients with restricted neck movements: a randomized comparative study
Airway success
203
2008
J Cardiothorac Vasc Anesth
Jugular bulb venous oxygen saturation during one-lung ventilation under sevoflurane- or propofol-based anesthesia for lung surgery
Cerebral desaturation
52
2008
NEJM
Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty
Deep Venous Thrombosis
3364
2007
J Neurosurg Anesthesiol
The Effect of Intensive Insulin Therapy on Infection Rate, Vasospasm, Neurologic Outcome, and Mortality in Neurointensive Care Unit After Intracranial Aneurysm Clipping in Patients With Acute Subarachnoid Hemorrhage. A Randomized Prospective Pilot Trial
Infection
78
2007
Anaesth Int Care
Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery
Delirium
126
2007
Anaesthesia
Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium
Curarization
338
2007
J Cardiothorac Vasc Anesth
Fenoldopam infusion for renal protection in high-risk cardiac surgery patients: a randomized clinical study
AKI
194
2006
Anesthesiology
Comparison of Plastic Single-use and Metal Reusable Laryngoscope Blades for Orotracheal Intubation during Rapid Sequence Induction of Anesthesia
Airway Failure
284
2006
JAMA
Prevention of Nosocomial Infection in Cardiac Surgery by Decontamination
of the Nasopharynx and Oropharynx With Chlorhexidine Gluconate. A Randomized Controlled Trial
Infection
991
2006
JAMA
Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial
Pulmonary
279
2005
J Clin Anesth
Intraoperative myocardial ischemia in peripheral vascular surgery: general anesthesia vs combined sciatic and femoral nerve blocks
Myocardial Ischemia
50
2005
Anesthesiology
Prevention of hypotension during spinal anesthesia for cesarean delivery: an effective technique using combination phenylephrine infusion and crystalloid cohydration
Hemodynamic
112
2005
JAMA
Prophylactic Oral Amiodarone for the Prevention of Arrhythmias that Begin Early After Revascularization, Valve Replacement, or Repair: PAPABEAR: a randomized controlled trial
Arrythmia
601
2005
JAMA
Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial
Intubation
209
2004
Anaesth Int Care
Gum Elastic Bougie-guided Insertion of the ProSeal Laryngeal Mask Airway
Airway success
100
2004
Anesth Analg
Continuous positive airway pressure versus noninvasive pressure support ventilation to treat atelectasis after cardiac surgery
Atelectasis
150
2004
JAMA
Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population: a randomized controlled trial
Infection
160
2004
Can J Anaesth
Aprotinin decreases the incidence of cognitive deficit following CABG and cardiopulmonary bypass: a pilot randomized controlled study
Cognitive Dysfunction
36
2003
BJA
Randomized comparison of the classic Laryngeal Mask Airway with the Airway Management Device during anaesthesia
Airway Failure
100
2003
J Neurosurg Anesthesiol
Hemodynamic Stability, Myocardial Ischemia, and Perioperative Outcome After Carotid Surgery with Remifentanil/Propofol or Isoflurane/Fentanyl Anesthesia
Cardiac Ischemia
59
2003
Acta Anaesthesiol Scand
Slow rewarming improves jugular venous oxygen saturation during rewarming
Cerebral Oxygen Desaturation
100
2003
Anesth Analg
Recovery of neuromuscular function after cardiac surgery: pancuronium versus rocuronium
Curarization
82
2003
Anesthesiology
Preoperative Cardiac Events in Elderly Patients with Hip Fracture Randomized to Epidural or Conventional Analgesia
Cardiac Event
68
2002
Anesth Analg
Endotracheal Intubation with a Gum-Elastic Bougie in Unanticipated Difficult Direct Laryngoscopy: Comparison of a Blind Technique Versus Indirect Laryngoscopy with a Laryngeal Mirror
Airway Failure
60
2002
Anesthesiology
A Multicenter Study Comparing the ProSeal and Classic Laryngeal Mask Airway in Anesthetized, Nonparalyzed Patients
Airway success
384
2002
Can J Anaesth
Antidepressant treatment for chronic depressed patients should not be discontinued prior to anesthesia
Delirium
80
2002
EJA
Myocardial Ischemia in Ptients with Impaired Left VEntricular Function Undeergoing Coronary Artery Bypass Grafting - Milrinone versus Nifedipine
Cardiac Ischemia
30
2002
Anesth Analg
The Effect of Lidocaine on Early Postoperative Cognitive Dysfunction After Coronary Artery Bypass Surgery
Cognitive Dysfunction
118
2002
Anesthesiology
Effectiveness of acute normovolemic hemodilution to minimize allogeneic blood transfusion in major liver resections
Blood Transfusion
78
2002
Lancet
Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial
Eclampsia
10141
2002
Lancet
Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial
Composite
120
2001
Anesth Analg
A Prospective Randomized Study of the Potential Benefits of Thoracic Epidural Anesthesia and Analgesia in Patients Undergoing Coronary Artery Bypass Grafting
Arrythmia
420
2001
Anesthesiology
Gel Lubrication of the Tracheal Tube Cuff Reduces
Pulmonary Aspiration
Pulmonary Aspiration
36
2001
Anesth Analg
The Clinical Relevance of Embolic Events Detected by Transesophageal Echocardiography During Cemented Total Hip Arthroplasty: A Randomized Clinical Trial
Embolia
120
2001
Chest
Diltiazem treatment does not alter renal function after thoracic surgery
Arrythmia
330
2001
Lancet
Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial
Composite
317
2001
Lancet
Oral amiodarone for prevention of atrial fibrillation after open heart surgery, the Atrial Fibrillation Suppression Trial (AFIST): a randomised placebo-controlled trial
Arrythmia
220
2001
BJA
Fast-track cardiac anaesthesia in the elderly: effect of two different anaesthetic techniques on mental recovery
Cognitive Dysfunction
83
2001
BJA
Autologous blood transfusion in total knee replacement surgery
Blood Transfusion
231
2001
J Cardiothorac Vasc Anesth
Tranexamic acid in aortic valve replacement
Blood Transfusion
300
2000
Anaesth Int Care
The Prevention of Pulmonary Aspiration with Control of Tracheal Wall Pressure using a Silicone Cuff
Aspiration
12
2000
Anesth Analg
Nitrous Oxide-Induced Increased Homocysteine Concentrations Are Associated with Increased Postoperative Myocardial Ischemia in Patients Undergoing Carotid Endarterectomy
Cardiac Ischemia
90
2000
Lancet
Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP)
trial
Venous Thrombosis
13356
2000
Anesthesiology
Randomized trial of diaspirin cross-linked hemoglobin solution as an alternative to blood transfusion after cardiac surgery. The DCLHb Cardiac Surgery Trial Collaborative Group
Blood Transfusion
209
2000
Anesth Analg
Postoperative prophylactic administration of beta-adrenergic blockers in patients at risk for myocardial ischemia
Myocardial Ischemia
109
2000
Anaesthesia
Prophylactic amrinone for weaning from cardiopulmonary bypass
Cardio pulmonary BP weaning
234
2000
JAMA
Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial
Intubation
40
1999
Anaesthesia
A comparison of two silicone-reinforced tracheal tubes with different bevels for use with the intubating laryngeal mask
Airway success
70
1999
Anesth Analg
The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery
Myocardial Ischemia
26
1999
NEJM
The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group
Mortality
112
1999
BMJ
Double blind randomised controlled trial of effect of metoprolol on myocardial ischaemia during endoscopic cholangiopancreatography
Myocardial Ischemia
48
1998
Acta Anaesthesiol Scand
Puncture technique and postural postdural puncture headache. A randomised, double-blind study comparing transverse and parallel puncture
Postdural Punction Headache
218
1998
Acta Anaesthesiol Scand
Tactile evaluation of the response to double burst stimulation decreases, but does not eliminate, the problem of postoperative residual paralysis
Curarization
60
1998
Acta Anaesthesiol Scand
Postural post-dural puncture headache after spinal and epidural anaesthesia. A randomised, double-blind study
Postdural Punction Headache
224
1998
Acta Anaesthesiol Scand
Obstetric outcome following epidural analgesia with bupivacaine-adrenaline 0.25% or bupivacaine 0.125% with sufentanil--a prospective randomized controlled study in 1000 parturients
Instrumental Delivery
1000
1998
Anesthesiology
Beta Adrenergic Blockade Accelerates Conversion of Postoperative Supraventircular Tachyarrythmias
Arrythmia
64
1998
Anesthesiology
Prophylactic Atenolol Reduces Postoperative Myocardial Ischeia
Cardiac Ischemia
200
1997
J Cardiothorac Vasc Anesth
A Placebo-Controlled Trial Verifying the Efficacy of Milrinone in Weaning High-Risk Patients From Cardiopulmonary Bypass
CPB weaning
32
1997
BJA
Low molecular weight heparin associated with spinal anaesthesia and gradual compression stockings in total hip replacement surgery. Arar Study Group
Deep Venous Thrombosis
170
1997
J Cardiothorac Vasc Anesth
Perioperative metoprolol reduces the frequency of atrial fibrillation after thoracotomy for lung resection
Arrythmia
30
1997
NEJM
Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery
Arrythmia
124
1996
Anesthesiology
Small, Oral Dose of Clonidine Reduces the Incidence of Intraoperative Myocardial Ischemia in Patients Having Vascular Surgery
Cardiac Ischemia
297
1996
Chest
Chlorhexidine Gluconate 0.12% Oral Rinse Reduces the Incidence of Total
Nosocomial Respiratory Infection and Nonprophylactic Systemic Antibiotic Use
in Patients Undergoing Heart Surgery
Infection
353
1996
Anesth Analg
Tranexamic acid reduces transfusions and mediastinal drainage in repeat cardiac surgery
Blood Transfusion
31
1996
Chest
The efficacy of pneumatic compression stockings in the prevention of pulmonary embolism after cardiac surgery
Embolia
2786
1996
NEJM
Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group.
Adverse Cardiac Outcome
200
1995
Acta Anaesthesiol Scand
Perioperative Monitoring of Neuromuscular Transmission using Acceleromyography Prevents Residual neuromuscular block following pancuronium
Postoperative Residual Curarization
40
1995
Anaesthesia
Comparison between two fibrescopes with different diameter insertion cords for fibreoptic intubation
Airway failure
84
1995
Anesth Analg
Procaine is effective for minimizing postischemic ventricular fibrillation in cardiac surgery
Arrythmia
58
1994
Anaesth Intensive Care
High-dose aprotinin in cardiac surgery--a prospective, randomized study
Blood Transfusion
100
1994
Anaesth Intensive Care
Incidence of ventricular fibrillation after aortic cross-clamp release using lignocaine cardioplegia
Arrythmia
146
1993
J Cardiothorac Vasc Anesth
Clonidine Imrpoves Perioperative Myocardial Ischemia, Reduces Anesthetic Requirements, and Alters Hemodynamic Parameters in Patients Undergoing Coronary Artery Bypass Surgery
Cardiac Ischemia
43
1993
Anesth Analg
Myocardial Ischemia: A comparison between Isoflurane and Enflurane in Coronary Artery Bypass
Cardiac Ischemia
38
1993
Anesthesiology
Rnadomized Evaluation of Pulse Oxymetry in 20802 Patients: II. Perioperative Events and Postoperative Complications
Composite
20802
1993
Lancet
Beneficial effect of autologous blood transfusion on infectious complications after colorectal cancer surgery
Infection
120
1992
JAMA
Comparison of Warfarin and External Pneumatic Compression in Prevention of Venous Thrombosis After Total Hip Replacement
Deep Venous Thrombosis
220
BJA: British Journal pf Anaesthesia; EJA: European Journal of Anaesthesiology; Anesth Analg: Anesthesia & Analgesia; NEJM: The New England Journal of Medicine; JAMA: The Journal of American Mecial Association; BMJ: British Medical Journal; J Cardiothorac Vasc Anesth: Journal of Cardiothoracis and Vascular Anesthesia; J Neurosurg Anesthesiol: Journal of Neurosurgical Anesthesiology; Anaesth Int Care: Anaesthesia and Intensive Care; Acta Anaesthesiol Scand: Acta Anaesthesiologica Scandinavica; Can J Anaesth: Canadian Journal of Anaesthsia; J Clin Anesth: Journal of Clinical Anesthesia; Reg Anesth Pain Med: Regional Anesthesia and Pain Medicine; Minerva Anestesiol: Minerva Anestesiologica
eTable4 – Correlation matrix between continuous variables and fragility index
Fragility Index
Year of Publication
Impact Factor
Number of Patients
Subject lost to follow-up
Number of centers
Reported P - Value
Number of events
Number needed to Treat/Harm (Absolute Value)
Fragility Index
1
Year of Publication
0.1046*
1
Impact Factor
0.2826**
0.1232*
1
Number of Patients
0.3967****
0.1828*
0.5432****
1
Subject lost to follow-up
0.0878*
0.1256*
0.0674*
0.3233***
1
Number of Centers
0.1638*
0.0724*
0.5355****
0.4631****
0.1949*
1
Reported P- value
-0.7406****
-0.0649*
-0.1178*
-0.0924*
-0.0095*
-0.0351*
1
Number of events
0.4247****
0.2668*
0.3871****
0.7375****
0.2246*
0.3686****
-0.0829*
1
Number needed to Treat/Harm
(Absolute Value)
-0.0965*
0.0707*
0.4149****
0.8002****
0.2709**
0.4001****
0.2304*
0.4050****
1
*p >0.05, ** p≤0.05, *** p<0.01, **** p<0.001
eFIGURE 1. Scatterplot matrix between continuous variables
eFIGURE2. Fragility index as a function of number of patients recruited. Figure at the top right is an enlargement of the red rectangle.
eFIGURE3. Fragility index as a function of reported P–value. Red line: polynomial fit curve. Only values below 60 are reported to improve visibility