from the Cleveland Clinic tested the hypothesis that intraoperative care transitions among anesthesia providers are associated with postoperative complications. The records of 138,932 adult surgical patients at the Cleveland Clinic were reviewed, with a view toward assessing the association between total number of anesthesia handovers during a case and an adjusted collapsed composite of in-hospital mortality and major morbidity using multivariable logistic regression.Anesthesia care transitions were strongly associated with higher odds of experiencing any major in-hospital mortality/ morbidity (incidence of 8.8%, 11.6%, 14.2%, 17.0%, and 21.2% for patients with 0, 1, 2, 3, and ≥4 transitions; odds ratio, 1.08 [95% confidence interval {CI}, 1.05-1.10] for an increase of 1 transition category, P < 0.001). Care transitions among attending anesthesiologists or residents or nurse anesthetists were similarly associated with harm (odds ratio, 1.07 [98.3% CI, 1.03-1.12] for attending [incidence of 9.4%, 13.9%, 17.4%, and 21.5% for patients with 0, 1, 2, and ≥3 transitions] and 1.07 [1.04-1.1] for residents or nurses [incidence of 9.4%, 13.0%, 15.4%, and 21.2% for patients with 0, 1, 2, and ≥3 transitions], both P < 0.001). There was no difference between matched residentonly (8.5%) and nurse anesthetist-only (8.8%) cases on collapsed composite outcome (odds ratio, 1.00 [98.3% CI, 0.93-1.07]; P = 0.92). The investigators concluded that intraoperative anesthesia care transitions are markedly associated with worse outcomes, with a similar effect size for attending anesthesiologists, residents, and nurse anesthetists.