Perioperative effectiveness research using large databases

While the delivery of anaesthesia care is largely a safe process and adverse events are infrequent, they can have devastating consequences for patients and providers when they occur. Given concerns about the role of anaesthesia care in shaping long-term outcomes traditionally considered outside the scope of anaesthesiology, new avenues for perioperative research are being explored at a rapid rate by anaesthesia researchers. We propose that new research methodologies such as perioperative effectiveness research could shed useful insight into processes leading to improved clinical care if applied appropriately and optimally. In this article, we outline the basic concepts of perioperative outcomes and effectiveness research. We highlight many sources of data, both clinical and non-clinical, and evaluate their utility in perioperative research. We then discuss how to design a successful effectiveness study, focussing particularly on which questions in anaesthesiology would be most amenable to exploration with this method, thereby providing a guide for future research endeavours. (C) 2011 Elsevier Ltd. All rights reserved.