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Original Investigation
January 9, 2018

Association Between Handover of Anesthesia Care and Adverse Postoperative Outcomes Among Patients Undergoing Major Surgery

Author Affiliations
  • 1Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
  • 2Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
  • 3Institute of Clinical Evaluative Sciences, Western Site (ICES Western), London, Ontario, Canada
  • 4Arthur Labatt School of Nursing, University of Western Ontario, London, Ontario, Canada
  • 5Department of Surgery, University of Western Ontario, London, Ontario, Canada
  • 6Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
  • 7Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
  • 8Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
  • 9Institute of Clinical Evaluative Sciences, Central Site (ICES Central), Toronto, Ontario, Canada
  • 10Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
JAMA. 2018;319(2):143-153. doi:10.1001/jama.2017.20040
Key Points

Question  Is there an association between complete intraoperative handover of anesthesia care and adverse postoperative outcomes?

Findings  In this retrospective cohort study that included 313 066 adults undergoing major surgery, complete intraoperative handover of anesthesia care compared with no handover was significantly associated with a higher risk of a composite of all-cause death, hospital readmission, or major postoperative complications over 30 days (44% vs 29%).

Meaning  Complete handover of intraoperative anesthesia care was associated with adverse postoperative outcomes.

Abstract

Importance  Handing over the care of a patient from one anesthesiologist to another occurs during some surgeries and might increase the risk of adverse outcomes.

Objective  To assess whether complete handover of intraoperative anesthesia care is associated with higher likelihood of mortality or major complications compared with no handover of care.

Design, Setting, and Participants  A retrospective population-based cohort study (April 1, 2009-March 31, 2015 set in the Canadian province of Ontario) of adult patients aged 18 years and older undergoing major surgeries expected to last at least 2 hours and requiring a hospital stay of at least 1 night.

Exposure  Complete intraoperative handover of anesthesia care from one physician anesthesiologist to another compared with no handover of anesthesia care.

Main Outcomes and Measures  The primary outcome was a composite of all-cause death, hospital readmission, or major postoperative complications, all within 30 postoperative days. Secondary outcomes were the individual components of the primary outcome. Inverse probability of exposure weighting based on the propensity score was used to estimate adjusted exposure effects.

Results  Of the 313 066 patients in the cohort, 56% were women; the mean (SD) age was 60 (16) years; 49% of surgeries were performed in academic centers; 72% of surgeries were elective; and the median duration of surgery was 182 minutes (interquartile [IQR] range, 124-255). A total of 5941 (1.9%) patients underwent surgery with complete handover of anesthesia care. The percentage of patients undergoing surgery with a handover of anesthesiology care progressively increased each year of the study, reaching 2.9% in 2015. In the unweighted sample, the primary outcome occurred in 44% of the complete handover group compared with 29% of the no handover group. After adjustment, complete handovers were statistically significantly associated with an increased risk of the primary outcome (adjusted risk difference [aRD], 6.8% [95% CI, 4.5% to 9.1%]; P < .001), all-cause death (aRD, 1.2% [95% CI, 0.5% to 2%]; P = .002), and major complications (aRD, 5.8% [95% CI, 3.6% to 7.9%]; P < .001), but not with hospital readmission within 30 days of surgery (aRD, 1.2% [95% CI, −0.3% to 2.7%]; P = .11).

Conclusions and Relevance  Among adults undergoing major surgery, complete handover of intraoperative anesthesia care compared with no handover was associated with a higher risk of adverse postoperative outcomes. These findings may support limiting complete anesthesia handovers.

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