Anesthesiologist Handoffs Affect Post-Surgical Outcomes

A new study concludes that complete handover of intraoperative anesthesia is associated with a higher risk of adverse postoperative outcomes.

Researchers at the University of Western Ontario (UWO; London, Canada), the University of Toronto (Canada), and other institutions conducted a retrospective population-based study involving 313,066 adult patients in the province of Ontario who underwent major surgery expected to last at least two hours, and requiring a hospital stay of at least one night. The researchers compared complete intraoperative handover of anesthesia care to no handover, with the main outcome being a composite of death, hospital readmission, or major postoperative complications within 30 days.

The results showed that the number of patients undergoing surgery with anesthesiology care handover progressively increased each year of the study, reaching 2.9% in 2015. In the unweighted sample, the main outcome occurred in 44% of the complete handover group, compared to 29% of the no handover group. Following adjustment, complete handovers were significantly associated with an increased risk of all-cause death and major complications, but not with hospital readmission within 30 days of surgery. The study was published on January 9, 2018, in JAMA.

“It's one of the most important things we do as anesthesiologists. If that tube gets dislodged, then the patient could suffer from a lack of oxygen and die,” said lead author Philip Jones, MD, of UWO. “If I hand over that patient's care and that breathing tube comes out prematurely, or the patient doesn't do well when it's removed, and I haven't passed on to the next anesthesiologist how I managed to wiggle my finger to the right, and that's how the tube went in best, if they don't know that, then they may not be able to re-secure the airway, if the airway is lost, and that can lead to complications.”

“We have always assumed that if we did a proper handover that the effect on the patient would be 'care-neutral' – there may not be a benefit, but there probably won't be a detriment to the patient,” concluded Dr. Jones. “Unfortunately, what we found in a very large study is evidence of harm. There is evidence of increased deaths related to this, evidence of increasing complications, and these are serious complications, not minor complications.”

A growing body of literature suggests that there is something about intraoperative handoffs that may be placing patients at risk for harm. Several hypotheses have been suggested including prolonged vital sign derangements, delayed administration of antibiotics, or fluid overload. In addition, the downstream consequences of inadequate handoff to postoperative providers may place patients at risk for adverse outcomes.

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University of Western Ontario
University of Toronto