• Journal: JAMA

• PMID: 35665794

• Type of study: Randomized controlled trial

• Hypothesis

  • To evaluate whether an intraoperative handover of anesthesia care results in increased postoperative complications

• Methods

  • Twelve centers in Germany

  • 1817 subjects

    • Age 18 and older

    • ASA 3/4

    • Undergoing major surgery (estimated surgical time greater than 2 hours)

  • Groups

    • Subjects randomized in 1:1 fashion to an intraoperative handover of care or no handover of care

      • Handover of care was only specific to the anesthesiology physician caring for the patient in the OR

        • Hands-on care provided by attending physicians on their own or by anesthesiology trainees with attending supervision

  • Primary outcome

    • A composite of all-cause mortality, readmission to any hospital, or serious postoperative complication within 30 days

• Results

  • 13% in the Handover group did NOT have a handover of care, while 9% in the No Handover group DID have a handover of care

  • Primary outcome results

    • Handover group: 30.1%

    • No Handover group: 32.5%

      • OR 0.89 (95% CI 0.72 - 1.10)

• Strengths

  • • Preregistered

    • Multicenter

    • Few exclusion criteria

    • Included higher risk surgeries 

    • Moderate sample size

    • ASA 3 and 4 patients 

    • Central randomization

    • Blinding

    • Little loss to follow up

    • Appropriate statistical analysis 

• Weaknesses

  • Generalizability 

  • Lack of standardized handover protocol

  • Single blind 

  • Risk of performance bias

  • Discrepancy between supervisors and hands on

  • Did not include intraoperative complications 

  • Compliance failure

• Key Point: Patients randomized to an intraoperative handover of anesthesia care had a similar number of major postoperative complications as those with no handover of care.

JAMA. 2022 Jun 28;327(24):2403-2412