Handover of anesthesia care is associated with an increased risk of delirium in elderly after major noncardiac surgery: results of a secondary analysis

Abstract

In patients undergoing major surgery, complete handover of intraoperative anesthesia care is associated with adverse postoperative outcomes including high mortality and more major complications. The purpose of this study was to explore the association between the intraoperative complete handover between anesthesiologists and the occurrence of postoperative delirium. This was a secondary analysis of the database of a previously published clinical trial. Seven hundred patients aged 65 years or older, who were admitted to the intensive care unit after noncardiac surgery, were included. Delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit twice daily during the first 7 postoperative days. Other postoperative outcomes were also monitored. The association between the intraoperative complete handover of anesthesia care and the development of postoperative delirium was analyzed with a logistic regression model. Of the 700 enrolled patients, 111 (15.9%) developed postoperative delirium within 7 days. After correction for confounding factors, intraoperative complete handover between anesthesiologists was associated with an increased risk of postoperative delirium (OR 1.787, 95% CI 1.012–3.155, P = 0.046). Patients with intraoperative complete handover also had higher incidence of non-delirium complications ( P = 0.003) and stayed longer in hospital after surgery ( P = 0.002). For elderly patients admitted to the intensive care unit after noncardiac surgery, intraoperative complete handover of anesthesia care was associated with an increased risk of postoperative delirium. Chinese Clinical Trial Registry ( http://www.chictr.org.cn ): ChiCTR-TRC-10000802. Electronic supplementary material The online version of this article (10.1007/s00540-019-02627-3) contains supplementary material, which is available to authorized users.

Association Between Handover of Anesthesiology Care and 1-Year Mortality Among Adults Undergoing Cardiac Surgery

“…A 2020 systematic review 1 identified 6 quantitative studies on the potential impact of anesthesiology handover on more than 600 000 patients who underwent mostly noncardiac surgery. Of these studies, 5 demonstrated adverse outcomes associated with handover 2,3,[33][34][35] and 1 demonstrated a lack of association. 34,36 In their exploratory meta-analysis of 3 noncardiac studies 3,33 and 1 cardiac study, 2 the authors reported a pooled relative risk of 1.40 (95% CI, 1.19-1.65; I 2 = 98%) for mortality in patients who were exposed as compared to those not exposed to handover.…”

Association of intraoperative anaesthesia handovers with patient morbidity and mortality: a systematic review and meta-analysis

“…The included studies were evaluated using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. 4e6,9,15e17 The overall quality rating was 'good' for four of the studies 3,5,16,17 and 'fair' for the other four studies. 4,6,9,15 Ratings are included in Table 1.…”

“…Specifically, handover was associated with greater risk of in-hospital mortality, 4,5 major morbidity, 4,5 postoperative complications, 3,6,16 all-cause mortality at 30 days, 3 admission to ICU, 3 length of stay, 3 extended postoperative ventilation, 3 wound dehiscence, 3 bleeding, 3 pneumonia, 3 unplanned return to OR, 3 new onset haemodialysis, 3 and postoperative delirium. 17 A list of confounders accounted for by each of these studies is provided in Supplementary Appendix 2.…”

Preoperative management and postoperative delirium

“…PubMed search shows that more than 140 articles on postoperative delirium (POD) have been published (28 articles in anesthesia journals) between January 1 and April 30, 2019. Two such articles regarding POD were published in the February issue of this journal [1,2]. These articles raised two perioperative risk factors for POD, handover of anesthesia care [1] and postoperative hypotonic fluid administration [2].…”

“…Two such articles regarding POD were published in the February issue of this journal [1,2]. These articles raised two perioperative risk factors for POD, handover of anesthesia care [1] and postoperative hypotonic fluid administration [2]. As handover of anesthesia care for long-duration surgery is inevitable, this facet of POD may be difficult to reduce.…”