Association Between Handover of Anesthesia Care and Adverse Postoperative Outcomes Among Patients Undergoing Major Surgery
March, 2018
Journal: JAMA
PMID: 29318277
Type of study: Retrospective population-based cohort study
Hypothesis: Complete intraoperative handover of anesthesia care from one anesthesiologist to another is not associated with higher mortality or major complications up to 30 days postoperatively.
Methods: Patients in Ontario, Canada with complete intraoperative handover were compared with patients without a complete handover regarding postoperative outcomes (primary outcome was a composite of all-cause death, hospital readmission, or major postoperative complications, all within 30 postoperative days). Inclusion criteria included patients greater than 18 years of age undergoing major surgery expected to last at least 2 hours and require at least 1 night in the hospital. Data was derived from billing systems.
Results: 313,066 patients included in the study. 5941 (1.9%) patients underwent surgery with complete handover of anesthesia care. Complete handovers were 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).
Strengths: Large sample size, large population base with presumed diverse subject pool; variety of procedures
Weaknesses: Generalizability (hands-on anesthesia provided by physicians only); design is retrospective, non-randomized, not controlled; did not examine how handovers took place; no data on the experience of the replacement anesthesiologists or surgeon; higher likelihood of turnover with longer hours, but did not account for single surgeon and potential for fatigue
Key Point: Intraoperative handovers of anesthesia care may be associated with an increased risk of postoperative complications.