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

Results

Following exclusions (Figure 1), 12,111 (98.2%) of 12,330 available NSQIP cases were analyzed. As seen in Table 1, 2,586 (21.3%) were exposed to an attending handoff and 1320 (10.9%) were exposed to a complete handoff. This data represented the practice of 46 attending anesthesiologists, 76 anesthetists, and 52 residents or fellows. There were significant differences between the groups, including sex, ASA-PS classification, case length, BMI, and surgical specialty. In both cases, the single variable analysis showed that there was a significant increase in the rate of composite NSQIP adverse events amongst those exposed to either type of handoff. Due to these exploratory statistical differences in multiple baseline characteristics that were found on a single variable basis, further modeling was performed using binomial multivariable logistic regression to assess whether these potential associations with NSQIP adverse events were independently associated on a multivariable basis.

Figure 1.

Diagram of cases

On unadjusted logistic regression, an attending handoff was associated with an odds ratio (OR) of 1.58 (95% CI, 1.41 to 1.77) of an adverse event. Complete handoff was associated with an OR of 1.89 (95% CI, 1.64 to 2.17) of an adverse event. After adjusting for only the confounding variables of patient age, sex, and ASA-PS classification (1/2, 3, or 4/5), the OR for attending handoff and complete handoff decreased slightly (1.51 [95% CI, 1.35 to 1.70] and 1.76 [95% CI, 1.53 to 2.03], respectively) but remained significant. Added adjustment for case duration and evening or weekend case status resulted in the OR of an adverse event becoming nonsignificant for both attending handoff and complete handoff (1.05 [95% CI, 0.92 to 1.19] and 1.12 [95% CI, 0.96 to 1.31], respectively). The complete results from these models are presented in Figures 2 and 3.

Figure 2.

Complete results from a single variable, b four variable, and c six variable logistic regression analysis of the effect of attending handoff on the risk of experiencing a composite of NSQIP adverse events

Figure 3.

Complete results from a single variable, b four variable, and c six variable logistic regression analysis of the effect of complete handoff on the risk of experiencing a composite of NSQIP adverse events

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