Regulating AI in Perioperative Medicine: Data, Trust, and Evidence

Recorded at the Evidence Based Perioperative Medicine (EPBOM) World Congress in London, this TopMedTalk episode, presented by Andy Cumpstey, features Guy Ludbrook, Professor of Anaesthesia and Head of Acute Care Medicine at the University of Adelaide and resident Georgia Cadzow, discussing the Perioperative Quality Initiative (POQI) POQI is a not-for-profit that uses a formal Delphi process to distill evidence and expert consensus into publishable clinical recommendations on topics such as perioperative hypotension, acute kidney injury, delirium, health economics, and fluid therapy. Georgia describes the iterative POQI meeting format, including pre-reading, small-group drafting, plenary workshopping, and final voting requiring 85% agreement. The conversation focuses on recent POQI work on Enhanced Postoperative Care (EPOC) units—protocolized, short-stay (24–48 hour) care for medium-risk postoperative patients—covering benefits and harms, economic impacts, and quality indicators, alongside plans for shared core datasets, the EPOC Network, and a 2027 second EPOC World Congress.

Today's TopMedTalk AI podcast was recorded at the Association of Anaesthetists of Great Britain and Ireland in London. It features Andy Cumpstey and Desiree Chappell and their guests, John Whittle, honorary associate professor of Perioperative medicine at University College London and  Duncan McPherson, Head of the clinical team at QMD Services and Anesthesiologist and Honorary Professor at University College London. We discuss how early AI research shares core requirements with other research—especially data safety and governance—while medical device regulation applies the same legal principles to AI as to other devices: safety and performance, alongside separate data protection laws. Patient concerns focus on data use, trust, and whether AI use in care should require consent. The panel addresses "black box" models, evolving software, bias and generalisability. The conversation contrasts regulated medical devices with unregulated scientific publishing, noting risks from AI-generated fraudulent papers and limits of relying on peer-reviewed literature, while emphasizing critical appraisal and appropriate clinical implementation.

At the 58th Society for Obstetric Anesthesia and Perinatology (SOAP) meeting in Montreal, TopMedTalk hosts Mike Grocott and Desiree Chappell interview Heather Nixon, SOAP immediate past president and Section Chief for Obstetric Anesthesiology; Section Chief for Simulation, Education, and Training Department of Anesthesiology University of Illinois, about SOAP's educational mission, governance, outreach, and special interest groups. Nixon describes her focus on intraoperative pain during caesarean delivery after a sentinel event and how listening to patient narratives, including The Retrievals (Season 2), highlighted issues such as dismissal of pain, communication failures, and cultural bias. She outlines SOAP's toolkit response and UIC system changes: intraoperative pain scoring every 15 minutes in Epic, empowerment to speak up, workflow education, and quicker conversion to general anesthesia to prevent prolonged severe pain, and notes SOAP's patient-facing Painless Push website. Link to the The Retrievals: https://podcasts.apple.com/gb/podcast/the-retrievals/id1691599042

Recorded at ANZCA and the Faculty of Pain Medicine's Annual Scientific Meeting in Auckland, TopMedTalk hosts Andy Cumstey and Kate Leslie interview visiting pain research leaders, Professor Irene Tracey, the Vice-Chancellor of the University of Oxford and Professor Lesley Colvin, the Chair of Pain Medicine at the University of Dundee and an Honorary Consultant in Anaesthesia and Pain Medicine at NHS Tayside. They discuss how thinking has shifted from chronic pain as a simple transition from acute pain, to a distinct disease with separate mechanisms and early "pre-vulnerability" factors including stress-axis disruption and reduced endogenous inhibition. Colvin outlines epidemiological and neuroimaging evidence linking adverse childhood experiences, including repeated medical procedures, to higher risks of chronic pain and other long-term conditions, with reward-system blunting also seen in depression and more severe pain. Tracey explains the "Bayesian brain," where dominant priors can sustain pain, influencing treatment and trial design, while both highlight brain plasticity, emerging neurotech such as VR-based training, and behavior-change approaches to increase physical activity. -- The 2026 International Practicum on Cardiopulmonary Exercise Testing will be held at the Balmer Lawn Hotel in Brockenhurst, UK, from September 16th to 18th this year. It is organised by iPOETTS , the international perioperative testing and training society. Come and join us at this premier educational event designed for clinicians, scientists, and healthcare professionals interested in sport, exercise, and perioperative medicine. This is an International Perioperative Testing and Training Society accredited event so when you attend you can get your iPOETTS accreditation, showing that you are a practitioner who has reached a high, standardized level of competence in performing and interpreting Cardiopulmonary Exercise Testing (CPET) for patients preparing for major surgery. Go now to http://www.ebpom.org

At EBPOM 2026 live from the British Library in London, Joff Lacy and Imogen Fecher-Jones speak with Malcolm West and Tim Baker, clinical co-leads for the National Clinical Audit of Perioperative Care (NCAPC), an NHS England mandated and HQIP-funded initiative managed by the Royal College of Anaesthetists to audit major elective surgery in England and publicly funded Jersey. They outline the audit's denominator (major surgery with anaesthetist involvement and >24-hour stay), year-one focus cohorts (thoracic, major gynaecology, major hip/knee orthopaedics, and lower GI/colorectal surgery), and aims to improve data quality and reduce unwarranted variation. The team describes a rapid modified Delphi process involving 200+ professionals and 70+ patients to define core metrics, highlights plans to automate data collection via hospital electronic records, and explains local roles, an organisational survey, and the goal of ongoing expansion and long-term delivery. FOR MORE ON EBPOM IRELAND GO HERE: www.ebpom.org

This month's TopMedTalk Classic has been digitally remastered for you and we've added the Q&A which wasn't part of the original podcast. We're featuring a talk first broadcast in 2018, featuring BobbieJean Sweitzer, Systems Director, Preoperative Medicine, Inova Health, Falls Church, Virginia, and Professor of Medical Education, University of Virginia. BobbieJean discusses whether perioperative risk in frail patients can be managed, emphasizing that current risk tools underweight frailty and functional outcomes. Using cases and data from U.S. nursing home residents, she highlights high postoperative mortality and functional decline after procedures such as colectomy and breast surgery, arguing for multidisciplinary, patient-inclusive decision-making that considers nonoperative and palliative options. Sweitzer describes Northwestern's implementation of quick frailty and cognitive screening, plus interventions including anemia treatment, nutritional optimization, and elements of prehabilitation, noting evidence that screening can trigger goal clarification and more palliative care consults. In the Q&A, speakers debate frailty-tool consensus, motivating patient engagement, funding prehab services, interpretation of mortality reductions after screening, and strategies to influence surgeons' decision-making. Original podcasts: https://topmedtalk.libsyn.com/periop-medicine-sig18-can-perioperative-risk-in-the-frail-be-managed TopMedTalk: Periop SIG18 | Perioperative frailty - panel discussion

At the Collaborative Clinical Trials meeting in Prato, Italy, Mike Grocott and co-host Mark Priestley speak with Sachin Kheterpal, University of Michigan Medical School's Associate Dean for Research Information Technology and the Robert B Sweet Professor and Kelley M. Kidwell, Chair of the Department of Anesthesiology and Professor of Biostatistics at the University of Michigan School of Public Health and Senior Associate Dean for Faculty Affairs . Kidwell explains sequential multiple assignment randomized trials (SMART) as multi-stage designs that randomize at key decision points to evaluate treatment sequences, distinguishing them from adaptive trials and addressing misconceptions about sample size. Kheterpal describes the University of Michigan–led Multi-Center Perioperative Outcomes Group (MPOG), contrasting EHR-based automated extraction and individual provider feedback with manually collected programs like NSQIP, and discussing alignment with AQI/NACOR and inspiration from UK National Audit Projects to improve documentation for future inference. They note emerging use of large language models to extract outcomes from free-text notes, discuss pragmatic trial designs including THRIVE, and emphasize the value of close statistician–clinician collaboration and scientific humility, highlighting a BMJ talk on countering misinformation. For more information on EBPOM Dingle, go here now: www.ebpom.org

In this TopMedTalk perioperative profile, host Andy Cumpstey interviews Professor Dan Sessler, Vice President for Clinical and Outcomes Research and Professor of Anesthesiology and Biostatistics at UTHealth Houston (McGovern Medical School), about his career as a perioperative trialist with over 1,000 publications. Sessler describes his scientific family background, early inspiration from clinical trials through Henry Kaplan's Hodgkin's work, and a shift from planned pediatric oncology to anesthesiology. He recounts building a research career starting with perioperative thermoregulation at UCLA and UCSF, then expanding into broad outcomes research, ultimately founding a large Department of Outcomes Research at the Cleveland Clinic and advocating for large multicenter trials. He emphasizes mentorship, philanthropy, and his current focus on reducing postoperative mortality through better ward monitoring and prevention beyond "failure to rescue." - The 2026 International Practicum on Cardiopulmonary Exercise Testing will be held at the Balmer Lawn Hotel in Brockenhurst, UK, from September 16th to 18th this year. It is organised by iPOETTS , the international perioperative testing and training society. Come and join us at this premier educational event designed for clinicians, scientists, and healthcare professionals interested in sport, exercise, and perioperative medicine. This is an International Perioperative Testing and Training Society accredited event so when you attend you can get your iPOETTS accreditation, showing that you are a practitioner who has reached a high, standardized level of competence in performing and interpreting Cardiopulmonary Exercise Testing (CPET) for patients preparing for major surgery. Go now to http://www.ebpom.org

At The International Anesthesia Research Society (IARS) and Society of Critical Care Anesthesiologists (SOCCA) meeting in Montreal, TopMedTalk hosts Mike Grocott and former editor-in-chief Desiree Chappell speak with FAER board members Dr. Rebecca A. Aslakson, Chair and Professor with Tenure, Department of Anesthesiology, University of Vermont Health Network and Dr. Michael Gropper, Professor and Chair of the UCSF Department of Anesthesia and Perioperative Care, about the Foundation for Anesthesia Education and Research (FAER). We describe how FAER's early-career support—especially the Mentored Research Training Grant—helped launch our guest's own research trajectories and facilitates transition to larger funding, with about 60% of MRTG recipients later obtaining NIH funding. They outline FAER's origins (founded in 1986 in partnership with the ASA), funding mechanisms spanning medical students to early faculty, partnerships with multiple specialty organizations, and career development resources including networking, mock study sections, and a National Academy of Medicine collaboration, emphasizing mentorship and community as central to long-term research success. -- Find out more about EBPOM Dingle now: www.ebpom.org

In Scotland at St Andrews, TopMedTalk AI hosts Andy Cumpstey and James Bowness discuss AI in regional anaesthesia with Bernard Victor Delvaux, staff anesthesiologist at the Centre Hospitalier Privé Claude Galien in Quincy-sous-Sénart, France. Bowness describes a regional anaesthesia course using AI-augmented ultrasound imaging, augmented reality simulated needling, and cadaveric ultrasound with real needle insertion. Delvaux discusses his research in AI-assisted nerve recognition, explains supervised model development through large-scale ultrasound image annotation for GE Healthcare's C-NERF, and they explore how to evaluate AI beyond pixel-based metrics toward clinically oriented utility and safety, including differences in usefulness for trainees versus experts. They discuss model design across anatomical sites, the need for diverse training and external validation data, risks from poor image acquisition, and barriers such as trust and autonomy. Delvaux outlines priorities for ESRA's AI working group, focusing on AI literacy and faster, reliable evaluation guidance. -- The 2026 International Practicum on Cardiopulmonary Exercise Testing will be held at the Balmer Lawn Hotel in Brockenhurst, UK, from September 16th to 18th this year. It is organised by iPOETTS , the international perioperative testing and training society. Come and join us at this premier educational event designed for clinicians, scientists, and healthcare professionals interested in sport, exercise, and perioperative medicine. This is an International Perioperative Testing and Training Society accredited event so when you attend you can get your iPOETTS accreditation, showing that you are a practitioner who has reached a high, standardized level of competence in performing and interpreting Cardiopulmonary Exercise Testing (CPET) for patients preparing for major surgery. Go now to http://www.ebpom.org