Complete handover of intraoperative anesthesia care among adults undergoing major surgery is associated with a higher risk for adverse postoperative outcomes, according to the results of a study published in JAMA.

Philip M. Jones, MD, from the University Hospital-London Health Sciences Centre, Ontario, Canada, and colleagues conducted a retrospective population-based cohort study from April 1, 2009 to March 31, 2015 of adult patients aged 18 years and older. Participants underwent major surgeries that lasted at least 2 hours and required a hospital stay of at least 1 night.

Researchers compared complete intraoperative handover of anesthesia care from 1 anesthesiologist to another with surgeries without a handover of anesthesia care. The primary outcome was a composite of all-cause death, hospital readmission, or major postoperative complications within 30 postoperative days. Secondary outcomes were the individual components of the composite primary outcome.

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A total of 313,066 patients were included in the cohort. The median duration of surgery was 182 minutes, and 1.9% of patients underwent surgery with complete handover of anesthesia care. The primary outcome occurred in 44% of participants in the complete handover group compared with 29% of the no-handover group.

After adjustments, surgeries with a complete handover of care were significantly associated with an increased risk for the primary outcome (adjusted risk difference [aRD], 6.8%; P <.001), all-cause death (aRD, 1.2%; P =.002), and major complications (aRD, 5.8%; P <.001). However, there was no significant difference in hospital readmission within 30 days of surgery between the 2 groups (aRD, 1.2%; P =.11).

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The investigators note that complete handover was determined using a billing code, and misclassification may have occurred if the code was not properly recorded. Although the primary anesthesiologist’s level of experience was controlled for, the level of experience of the replacement anesthesiologist and that of the surgeon were not. Investigators also did not control for information on the timing of the handover, the presence of a second assistant anesthesiologist, or the presence of anesthesia trainees.

Given the statistically significant association between the complete handover of anesthesia care and adverse postoperative outcomes, the authors conclude that these findings may support limiting complete anesthesia handovers.


Jones PM, Cherry RA, Allen BN, et al. Association between handover of anesthesia care and adverse postoperative outcomes among patients undergoing major surgery. JAMA. 2018;319:143-153.