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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT04965324
Registration number
NCT04965324
Ethics application status
Date submitted
7/07/2021
Date registered
16/07/2021
Titles & IDs
Public title
Depth of Anaesthesia and Long-term Survival: The Balanced Anaesthesia Follow-up Study
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Scientific title
Depth of Anaesthesia and Long-term Survival in Elderly Surgical Patients: The Balanced Anaesthesia Study Long-term Follow-up Study
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Secondary ID [1]
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ACTRN12612000632897
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Secondary ID [2]
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A+9283
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Universal Trial Number (UTN)
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Trial acronym
BALANCEDLT
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Post-Operative Confusion
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Long Term Adverse Effects
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Surgery--Complications
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Cognitive Dysfunction, Postoperative
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Condition category
Condition code
Neurological
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0
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Other neurological disorders
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Mental Health
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0
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Other mental health disorders
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Public Health
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Other public health
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Surgery
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0
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Other surgery
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Intervention/exposure
Study type
Observational
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Patient registry
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
Anaesthesia Depth BIS 35 - BIS 35
Anaesthesia Depth BIS 50 - BIS 50
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Survival
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Assessment method [1]
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Survival
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Timepoint [1]
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Between one year and eight years after randomization to the BALANCED Trial
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Eligibility
Key inclusion criteria
Inclusion and exclusion criteria will be the same as the Balanced trial with participants limited to those sites described above. Survival data will be censored at date of accessing mortality database.
Inclusion
1. Age over 60 years and over
2. ASA physical status 3 or 4
3. Surgery expected to last over 2 hours
4. Hospital length of stay expected to be 2 nights or more
5. General anaesthesia with or without major regional block
6. Able to monitor BIS throughout anaesthesia
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Minimum age
60
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Exclusion
1. Unable to monitor BIS
2. Unable to consent
3. Surgery with 'wake up' test
4. Propofol infusion for part or all of maintenance of anaesthesia
5. Previous enrolment in Balanced study
Exclusion The intention-to-treat (ITT) population is defined as all randomised participants who met the inclusion and exclusion criteria who had surgery.
The per-protocol (PP) population is defined as all randomised participants in the study who meet all the inclusion/exclusion criteria for BALANCED with BIS group classified according to the actual median BIS value achieved irrespective of randomisation.
Participants were allocated to the BIS=50 group if the achieved median BIS is between 45 and 55 inclusive, and to the BIS=35 group if the achieved median BIS is between 30 and 40 inclusive. Participants who are not within these ranges will be excluded from these analyses.
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Study design
Purpose
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Duration
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Selection
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Timing
Prospective
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
19/12/2012
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
31/05/2021
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Sample size
Target
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Accrual to date
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Final
6644
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Recruitment in Australia
Recruitment state(s)
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Recruitment outside Australia
Country [1]
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New Zealand
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State/province [1]
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Auckland
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Funding & Sponsors
Primary sponsor type
Government body
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Name
Auckland City Hospital
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Address
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Country
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Other collaborator category [1]
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Other
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Name [1]
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Health Research Council, New Zealand
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Address [1]
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Country [1]
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Other collaborator category [2]
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Other
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Name [2]
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Australian and New Zealand College of Anaesthetists
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Address [2]
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Country [2]
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Ethics approval
Ethics application status
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Summary
Brief summary
Anaesthetic depth and complications after major surgery: an international, randomised controlled trial - The BALANCED trial. In this large, international, randomised controlled trial that enrolled patients aged 60 years and over with significant comorbidity and at increased risk of complications after major surgery, we found no evidence that light general anaesthesia (bispectral index 50) was superior to deep general anaesthesia (bispectral index 35) in reducing 1-year mortality. The BALANCED long term follow up study will look at whether depth of anesthesia affects long term (beyond 1 year) survival. The primary hypothesis is that targetting BIS 50 will result in superior long term survival compared to targetting BIS 35. The two secondary hypotheses are that BIS titration to BIS 50 will 1. reduce local cancer recurrence or metastatic spread and consequently improve long-term survival 2. reduce postoperative delirium and associated cognitive impairment and consequently improve long-term survival Both these mechanisms would be expected to take longer to manifest as reduced survival than 1-year all-cause mortality primary outcome in the Balanced trial. Trials of cancer outcomes often use 5-year survival or similar timeframes to determine evidence of clinical benefit. A steeper cognitive trajectory due to intermediate outcomes such as delirium and cognitive impairment may take longer than 1 year to produce a clinically important difference in survival 30. The 10.6% relative risk reduction seen in the Balanced trial could translate to a statistically and clinically meaningful survival difference in this high-risk population. This population may have 5-year survival of \~80% translating to an absolute survival difference of \~2% potentially (if the \~10% RRR is maintained beyond 1 year). The alternative is that there is no long-term mortality difference which would provide continuing clinical guidance of the safety of current practice in patients who are not at high risk of delirium. This study could provide a rationale for trials in larger populations (such as the total Balanced trial population) or targeted subgroups such as cancer and delirium to provide further mechanistic insights. Long-term survival is an important patient-centred outcome. The mechanisms described above may manifest in longer-term outcomes providing a clear rationale for the current trial.
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Trial website
https://clinicaltrials.gov/study/NCT04965324
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Timothy Dr Short
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Address
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Auckland City Hospital
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
Data sharing requests will be assessed by the Balanced Study Steering.Committee.
Individual, deidentified participant data used in these analyses will be shared 2 years after publication by request from any qualified investigator after approval of a protocol, statistical analysis plan, and receipt of a signed data access agreement via the Research Office of Auckland District Health Board, New Zealand; and after obtaining the approval of the New Zealand Health and Disability Ethics Committees for the project and data release
Supporting document/s available: Study protocol, Statistical analysis plan (SAP), Informed consent form (ICF)
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When will data be available (start and end dates)?
within 2 years
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Available to whom?
Will be available on the clintrials.govt website
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Available for what types of analyses?
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How or where can data be obtained?
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT04965324