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Author Notes:

Grant C. Lynde, Phone: +1-404-778-0695, Email: glynde@emory.edu

VNOS: This author acquired the data, wrote the statistical analysis plan, cleaned and analyzed the data, drafted and critically revised the manuscript, and approved the final version.

VGM: This author interpreted the data, drafted the manuscript and approved the final version.

CLS: This author interpreted the data, critically revised the manuscript and approved the final version.

CSJ: This author interpreted the data, critically revised the manuscript and approved the final version.

GCL: This author conceived the work, acquired the data, interpreted the data, drafted and critically revised the manuscript, and approved the final version.

All authors read and approved the final manuscript.

The authors would like to acknowledge the contributions of Lisa Cogdill, MPH, Emory University Department of Libraries and Information Technology, Atlanta, GA, USA, for her assistance in performing the EHC CDW queries.

We would also like to acknowledge the contribution of Benjamin Amoateng, MPH, Emory University Department of Anesthesiology, Atlanta, GA, USA, for his assistance in merging the NSQIP and EHC CDW datasets.

The authors declare that they have no competing interests.


Research Funding:

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

The Emory University Department of Anesthesiology generously supported the time of the authors in producing this work.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Anesthesiology
  • Patient safety
  • Communication
  • Patient handoff
  • RISK

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


Journal Title:

BMC Anesthesiology


Volume 19, Number 1


, Pages 182-182

Type of Work:

Article | Final Publisher PDF


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.

Copyright information:

© 2019 The Author(s).

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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