title: Impact of anesthetic handover on mortality and morbidity in cardiac surgery: a cohort study.
abstract: OBJECTIVE
  Clinical handover is a critical moment in patient care. The authors tested the hypothesis that handover of anesthesia care is associated with increased mortality and morbidity in patients undergoing cardiac surgery.
  
  
  METHODS
  This was a single-center, retrospective cohort study of prospectively collected data.
  
  
  METHODS
  The study was conducted in a quaternary care cardiac surgery center and university research hospital.
  
  
  METHODS
  All patients undergoing cardiac surgical procedures between April 1, 1999 and October 31, 2009 were included in the study.
  
  
  METHODS
  Propensity-score matching was used to adjust for differences between patients who received intraoperative handover of anesthesia care and those who did not, and in-hospital mortality and morbidity were compared using multivariate logistic modeling.
  
  
  RESULTS
  14,421 patients met the inclusion criteria for this study; handover occurred in 966 cases (6.7%). After propensity-score matching, 7,137 patients were included for analysis. In-hospital mortality was 5.4% in the handover group and 4.0% in the non-handover group (match-adjusted odds ratio, 1.425; 95% confidence interval, 1.013-2.006; p = 0.0422); the incidence of major morbidity was 18.5% in the handover group and 15.6% in the non-handover group (match-adjusted odds ratio, 1.274; 95% confidence interval, 1.037-1.564; p = 0.0212).
  
  
  CONCLUSIONS
  Handover of anesthetic care during cardiac surgery is associated with a 43% greater risk of in-hospital mortality and 27% greater risk of major morbidity. Further studies are required to explore this relationship and to systematically evaluate and improve the process of handover.
authors.affiliation: Division of Cardiac Anesthesiology and Critical Care Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: chudson@ottawaheart.ca.
authors.forename: Christopher C C
authors.initials: CC
authors.lastname: Hudson
authors.affiliation: Division of Cardiac Anesthesiology and Critical Care Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Bernard
authors.initials: B
authors.lastname: McDonald
authors.affiliation: Department of Anesthesiology, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Jordan K C
authors.initials: JK
authors.lastname: Hudson
authors.affiliation: Division of Cardiac Anesthesiology and Critical Care Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Diem
authors.initials: D
authors.lastname: Tran
authors.affiliation: Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Munir
authors.initials: M
authors.lastname: Boodhwani
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D000777:Anesthetics / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D062209:Patient Handoff / Q000592:standards; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D000777:Anesthetics
keywords: anesthesiology; cardiac surgery; handover; patient safety