Perioperative Medicine  |   October 2016
Intraoperative Care Transitions Are Not Associated with Postoperative Adverse Outcomes
Author Notes
  • From the Vanderbilt Departments of Anesthesiology (M.A.T., J.M.E., J.P.W.), Biomedical Informatics (J.M.E., J.P.W.), Surgery (J.M.E., O.D.G.), and Health Policy (J.M.E.), Nashville, Tennessee; Anesthesia Quality Institute, Schaumburg, Illinois (R.P.D.); and Quality, Safety and Risk Prevention, Vanderbilt University Medical Center, Nashville, Tennessee (B.J.M.).
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Submitted for publication October 15, 2015. Accepted for publication June 21, 2016.
    Submitted for publication October 15, 2015. Accepted for publication June 21, 2016.×
  • Address correspondence to Dr. Terekhov: Vanderbilt Department of Anesthesiology, 1211 21st Avenue South Medical Arts Building 708, Nashville, Tennessee 37212. maxim.terekhov@vanderbilt.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Patient Safety / Quality Improvement
Perioperative Medicine   |   October 2016
Intraoperative Care Transitions Are Not Associated with Postoperative Adverse Outcomes
Anesthesiology 10 2016, Vol.125, 690-699. doi:10.1097/ALN.0000000000001246
Anesthesiology 10 2016, Vol.125, 690-699. doi:10.1097/ALN.0000000000001246
Abstract

Background: Whether anesthesia care transitions and provision of short breaks affect patient outcomes remains unclear.

Methods: The authors determined the number of anesthesia handovers and breaks during each case for adults admitted between 2005 and 2014, along with age, sex, race, American Society of Anesthesiologists physical status, start time and duration of surgery, and diagnosis and procedure codes. The authors defined a collapsed composite of in-hospital mortality and major morbidities based on primary and secondary diagnoses. The relationship between the total number of anesthesia handovers during a case and the collapsed composite outcome was assessed with a multivariable logistic regression. The relationship between the total number of anesthesia handovers during a case and the components of the composite outcome was assessed using multivariate generalized estimating equation methods. Additionally, the authors analyzed major complications and/or death within 30 days of surgery based on the American College of Surgeons National Surgical Quality Improvement Program–defined events.

Results: A total of 140,754 anesthetics were identified for the primary analysis. The number of anesthesia handovers was not found to be associated (P = 0.19) with increased odds of postoperative mortality and serious complications, as measured by the collapsed composite, with odds ratio for a one unit increase in handovers of 0.957; 95% CI, 0.895 to 1.022, when controlled for potential confounding variables. A total of 8,404 anesthetics were identified for the NSQIP analysis (collapsed composite odds ratio, 0.868; 95% CI, 0.718 to 1.049 for handovers).

Conclusions: In the analysis of intraoperative handovers, anesthesia care transitions were not associated with an increased risk of postoperative adverse outcomes.