Lack of Association Between Intraoperative Handoff of Care and Postoperative Complications

A Retrospective Observational Study

Vikas N. O'Reilly-Shah; Victoria G. Melanson; Cinnamon L. Sullivan; Craig S. Jabaley; Grant C. Lynde

Disclosures

BMC Anesthesiol. 2019;19(182) 

In This Article

Background

Intraoperative transitions of anesthetic care, also referred to as handoffs or handovers, are a potential source of adverse events.[1–3] Handoffs represent both an opportunity for better-rested providers to heighten vigilance but also are a potential source of medical errors and heterogeneous clinical care.[2,3] Examining their impact is important to identify opportunities to improve patient safety but potentially fraught by confounding. For example, surgical case length has been associated both with handoffs and adverse postoperative events.[4,5]

Previous large retrospective investigations exploring the association between handoffs and adverse clinical outcomes have found conflicting results, potentially owing to differences in care models or the analytic approach to confounders.[6] In a recent examination of retrospective data from over 300,000 anesthetics in Ontario, Canada, handoffs were associated with an increased risk of death, readmission, and major complications within 30 days.[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 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.[10] Measures included in the NSQIP composite outcome are: progressive or acute renal failure, cardiac arrest requiring cardiopulmonary resuscitation, stroke, any type of surgical site infection or sepsis, myocardial infarction, unplanned intubation, mechanical ventilation greater than 48 h, pneumonia, deep vein thrombosis, venous thromboembolism, urinary tract infection, or readmission within 30 days.

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