Intraoperative Care Transitions Are Not Associated with Postoperative Adverse Outcomes

Abstract

Background Whether anesthesia care transitions and provision of short breaks affect patient outcomes remains unclear. Methods The authors determined the number of anesthesia handovers and breaks during each case for adults admitted between 2005 and 2014, along with age, sex, race, American Society of Anesthesiologists physical status, start time and duration of surgery, and diagnosis and procedure codes. The authors defined a collapsed composite of in-hospital mortality and major morbidities based on primary and secondary diagnoses. The relationship between the total number of anesthesia handovers during a case and the collapsed composite outcome was assessed with a multivariable logistic regression. The relationship between the total number of anesthesia handovers during a case and the components of the composite outcome was assessed using multivariate generalized estimating equation methods. Additionally, the authors analyzed major complications and/or death within 30 days of surgery based on the American College of Surgeons National Surgical Quality Improvement Program–defined events. Results A total of 140,754 anesthetics were identified for the primary analysis. The number of anesthesia handovers was not found to be associated (P = 0.19) with increased odds of postoperative mortality and serious complications, as measured by the collapsed composite, with odds ratio for a one unit increase in handovers of 0.957; 95% CI, 0.895 to 1.022, when controlled for potential confounding variables. A total of 8,404 anesthetics were identified for the NSQIP analysis (collapsed composite odds ratio, 0.868; 95% CI, 0.718 to 1.049 for handovers). Conclusions In the analysis of intraoperative handovers, anesthesia care transitions were not associated with an increased risk of postoperative adverse outcomes.

Training in intraoperative handover and display of a checklist improve communication during transfer of care

“…Hudson et al found an important link between intraoperative handovers during cardiac surgery and in-hospital mortality, and a similar association was found among patients undergoing other forms of surgery. 1–3 However, a recent study by Terekhov et al 18 did not find that the number of anaesthesia handovers was associated with increased odds of postoperative mortality and serious complications. To date, all studies on intraoperative anaesthesia handovers and morbidity/mortality have analysed only retrospective data and are thus subject to significant methodological limitations, such as bias resulting from confounding factors (e.g.…”

“…To date, all studies on intraoperative anaesthesia handovers and morbidity/mortality have analysed only retrospective data and are thus subject to significant methodological limitations, such as bias resulting from confounding factors (e.g. the study by Terekhov et al 18 was performed at an institution where a detailed PACU handover protocol with teaching sessions had just been implemented).…”

Lack of association between intraoperative handoff of care and postoperative complications: a retrospective observational study

“…(1) In contrast, a prior examination of over 140,000 anesthetics within a large American university hospital, adjusted for case severity, duration, surgical complexity, and patient comorbidities, found no association between handoffs and adverse outcomes. (7) Effect estimates vary widely within other similar investigations. (2,8,9) We sought to further examine the association between handoffs of anesthetic care in our care team…”

Lack of association between intraoperative handoff of care and postoperative complications: a retrospective observational study

“…[6] In contrast, a prior examination of over 140,000 anesthetics within a large American university hospital, adjusted for case severity, duration, surgical complexity, and patient comorbidities, found no association between handoffs and adverse outcomes. [7] Effect estimates vary widely within other similar investigations. [1,8,9] We sought to further examine the association between handoffs of anesthetic care in our care team model and a composite measure of adverse postoperative outcomes using The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), as its definitions have been validated.…”

“…Conversely, handoffs allow for rested personnel to assume care, heighten vigilance and performance, and therefore possibly mitigate these risks. Estimates of handoff effects have varied widely in prior investigations; however, estimates of their effect in larger, more robust investigations have been modest [1,[6][7][8]. Effect estimates may therefore be influenced by sample size, case mix, and the relative balance of error introduction versus harm mitigation influenced by local practice.Another potential explanation for the incongruity of our results with prior investigations may be that local practice patterns or experience surrounding handoffs and postoperative care can mitigate their potential harm.…”