title: Intraoperative transitions of anesthesia care and postoperative adverse outcomes.
abstract: BACKGROUND
  Transfers of patient care and responsibility among caregivers, "handovers," are common. Whether handovers worsen patient outcome remains unclear. The authors tested the hypothesis that intraoperative care transitions among anesthesia providers are associated with postoperative complications.
  
  
  METHODS
  From the records of 138,932 adult Cleveland Clinic (Cleveland, Ohio) surgical patients, the authors assessed the association between total number of anesthesia handovers during a case and an adjusted collapsed composite of in-hospital mortality and major morbidities using multivariable logistic regression.
  
  
  RESULTS
  Anesthesia care transitions were significantly associated with higher odds of experiencing any major in-hospital mortality/morbidity (incidence of 8.8, 11.6, 14.2, 17.0, and 21.2% for patients with 0, 1, 2, 3, and ≥ 4 transitions; odds ratio 1.08 [95% CI, 1.05 to 1.10] for an increase of 1 transition category, P < 0.001). Care transitions among attending anesthesiologists and residents or nurse anesthetists were similarly associated with harm (odds ratio 1.07 [98.3% CI, 1.03 to 1.12] for attending [incidence of 9.4, 13.9, 17.4, and 21.5% for patients with 0, 1, 2, and ≥ 3 transitions] and 1.07 [1.04 to 1.11] for residents or nurses [incidence of 9.4, 13.0, 15.4, and 21.2% for patients with 0, 1, 2, and ≥ 3 transitions], both P < 0.001). There was no difference between matched resident only (8.5%) and nurse anesthetist only (8.8%) cases on the collapsed composite outcome (odds ratio, 1.00 [98.3%, 0.93 to 1.07]; P = 0.92).
  
  
  CONCLUSIONS
  Intraoperative anesthesia care transitions are strongly associated with worse outcomes, with a similar effect size for attendings, residents, and nurse anesthetists.
authors.affiliation: From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (L.S., B.D.H., J.Y., A.T., E.J.M., D.I.S., A.K.) and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (J.Y., E.J.M.).
authors.forename: Leif
authors.initials: L
authors.lastname: Saager
authors.forename: Brian D
authors.initials: BD
authors.lastname: Hesler
authors.forename: Jing
authors.initials: J
authors.lastname: You
authors.forename: Alparslan
authors.initials: A
authors.lastname: Turan
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mascha
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.forename: Andrea
authors.initials: A
authors.lastname: Kurz
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000009:adverse effects* / Q000592:standards; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007430:Intraoperative Care / Q000009:adverse effects* / Q000401:mortality* / Q000592:standards; D008297:Male; D008875:Middle Aged; D062209:Patient Handoff / Q000592:standards; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D016896:Treatment Outcome