• Jessica Spence, Emilie Belley-Côté, Shun Fu Lee, Shrikant Bangdiwala, Richard Whitlock, Yannick LeManach, Summer Syed, Andre Lamy, Eric Jacobsohn, Sarah MacIsaac, P J Devereaux, and Stuart Connolly.
• Departments of Anesthesia and Critical Care and Health Research Methods, Evidence, and Impact, Population Health Research Institute (PHRI), McMaster University, 2V9 - 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada. jessicaspence13@gmail.com.
• Can J Anaesth. 2018 Jul 1; 65 (7): 813-821.

AbstractIncreasingly, clinicians and researchers recognize that studies of interventions need to evaluate not only their therapeutic efficacy (i.e., the effect on an outcome in ideal, controlled settings) but also their real-world effectiveness in broad, unselected patient groups. Effectiveness trials inform clinical practice by comparing variations in therapeutic approaches that fall within the standard of care. In this article, we discuss the need for studies of comparative effectiveness in anesthesia and the limitations of individual patient randomized-controlled trials in determining comparative effectiveness. We introduce the concept of randomized cluster crossover trials as a means of answering questions of comparative effectiveness in anesthesia, using the design of the Benzodiazepine-Free Cardiac Anesthesia for Reduction in Postoperative Delirium (B-Free) trial (Clinicaltrials.gov identifier NCT03053869).

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