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

• Type of Material: Article
• Authors: Vikas N. O'Reilly-Shah, Emory University; Victoria G. Melanson, Emory University; Cinnamon Sullivan, Emory University; Craig Jabaley, Emory University; Grant Lynde, Emory University
• Language: English
• Date: 2019-10-15
• Publisher: BMC (part of Springer Nature)
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12871-019-0858-8
• Title of Journal or Parent Work: BMC Anesthesiology
• ISSN: 1471-2253
• Volume: 19
• Issue: 1
• Start Page: 182
• End Page: 182
• Grant/Funding Information: The Emory University Department of Anesthesiology generously supported the time of the authors in producing this work.; This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
• Keywords: HANDOVERS; TRANSITIONS; RISK; QUALITY; Science & Technology; Patient safety; ANESTHESIA CARE; Patient handoff; Life Sciences & Biomedicine; Anesthesiology; Communication
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery

Abstract

Background: The significance of intraoperative anesthesia handoffs on patient outcomes are unclear. One aspect differentiating the disparate results is the treatment of confounding factors, such as patient comorbidities and surgery time of day. We performed this study to quantify the significance of confounding variables on composite adverse events during intraoperative anesthesia handoffs. Methods: In this retrospective study, we analyzed data from the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP). We examined the effects of intraoperative handoffs between anesthesia personnel. A total of 12,111 cases performed examined at two hospitals operated by a single healthcare system that were that included in the ACS NSQIP database performed. The presence of attending and anesthetist or resident handoffs, patient age, sex, body mass index, American Society of Anesthesiologists Physical Status (ASA-PS) classification, case length, surgical case complexity, and evening/weekend start time were measured. Results: A total of 2586 of all cases in the NSQIP dataset experienced a handoff during the case. When analyzed as a single variable, attending handoffs were associated with higher rates of adverse outcomes. However, once confounding variables were added into the analysis, attending handoffs and complete care transitions were no longer statistically significant. Conclusions: Inclusion of significant covariates is essential to fully understanding the impact provider handoffs have on patient outcomes. Case timing and lengthy case duration are more likely to result in both a handoff and an adverse event. The impact of handoffs on patient outcomes seen in the literature are likely due, in part, to how covariates were addressed.