Complete anesthesia handover during cardiac surgery associated with patient mortality

1. This large, retrospective cohort study demonstrated that complete anesthesia handover during cardiac surgery was associated with a greater risk of mortality at 30-days and at 1-year as well as an increased risk of prolonged hospital and intensive care unit length of stay.

Evidence Rating Level: 2 (Good)

Study Rundown: Handover of care intraoperatively is a frequent practice for anesthesiologists to prevent physician burnout and fatigue. However, patient safety may be at risk if critical information during handover is not communicated effectively from one anesthesiologist to the next. This retrospective, multi-centre, cohort study evaluated whether outcomes for patients undergoing cardiac surgery differed if there was complete anesthesia handover (replacement anesthesiologist completes the case) compared to no handover. Adult patients (n= 102 156) from Ontario who underwent cardiac surgery between October 1, 2008, and September 30, 2019, were included. The co-primary outcomes were all-cause mortality at 30 days and 1-year post-surgery; other outcomes examined hospital and intensive care unit (ICU) length of stay (LOS) postoperatively. Complete anesthesia handover was identified using a specific billing code. Overall, 1926 (1.9%) procedures underwent complete handover, and the rate was over three times greater in 2019 (2.9%) than in 2008 (0.7%). Complete handover demonstrated an increased risk of 30-day mortality (hazard ratio [HR]: 1.89 [95% CI: 1.41-2.54]) and 1-year mortality (HR: 1.66 [95% CI: 1.31-2.12]). Furthermore, there was also an greater risk of prolonged LOS in the hospital (relative risk [RR]: 1.17 [95% CI: 1.06-1.28]) and in the ICU (RR: 1.43 [95% CI: 1.22-1.68]). There were no significant increases in the risk of patient-defined adverse cardiac and non-cardiac events (PACE) at 30-days (HR: 1.09 [95% CI 0.79-1.49]) and at 1-year (HR: 0.89 [95% CI:  0.70-1.13]) in the complete handover cohort. Overall, this study demonstrated significant associations between several perioperative patient outcomes and complete anesthesia handover during cardiac surgery. This study included a large sample size with follow-up beyond the perioperative period. One limitation, however, is that data pertaining to the timing of handover were not collected, which could shed light on when the risk of negative outcomes is greatest. Since physician wellbeing is critical, it is important to identify optimal windows to perform handover while maintaining patient safety.

Click to read the study in JAMA Network Open

Click to read an accompanying editorial in JAMA Network Open

Relevant Reading: Association between handover of anesthesia care and adverse postoperative outcomes among patients undergoing major surgery

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