Platform trials in anaesthesia and perioperative medicine: a scoping review. [Review]

Abstract

Background: Traditional randomized control trials underpin evidence generation in anaesthesia and perioperative medicine, but are often poorly suited to evaluating multiple, evolving clinical questions. Platform trials encorporate a trial design that evaluates multiple interventions within one or more domains, is governed centrally using a master or core protocol, and has the capacity to add new research questions through the addition of new treatments and/or subgroup. Platform trials offer a flexible alternative, enabling the concurrent and sequential evaluation of multiple interventions and more efficient identification of effective or harmful treatments.

Methods: We conducted a scoping review using the Joanna Briggs Institute methodology, reported in accordance with PRISMA-ScR. Searches of bibliographic databases, grey literature and clinical trial registries (Ovid MEDLINE, Ovid Embase, Scopus, CINAHL Complete, Web of Science and the Cochrane Library) were undertaken. Records meeting an a priori definition of platform trials in anaesthesia or perioperative medicine were included. Trial design and methodological features were extracted and synthesised descriptively.

Results: Among 32 062 records identified, nine platform trials met eligibility criteria. Most were registered (8/9) and university-sponsored, with nearly half in the planning phase. All trials were multicentre, predominantly conducted in high-income countries and 44% involved international collaboration. Adult surgical populations were most commonly studied, with surgical site infection prevention being the leading perioperative focus. Across the nine platform trials, 24 interventions were evaluated, predominantly surgical (58.3%), followed by anaesthetic (12.5%). Adaptive features were universal, and Bayesian statistical methods predominated.

Conclusions: Platform trials remain uncommon and methodologically diverse in anaesthesia and perioperative medicine, reflecting early-stage adoption within an evolving field. Greater consensus regarding nomenclature, governance, and methodological standards, alongside expansion into anaesthesia-specific domains, is needed to realise their efficiency and ethical advantages.