title: Anesthesia Care Transitions and Risk of Postoperative Complications.
abstract: BACKGROUND
  A patient undergoing surgery may receive anesthesia care from several anesthesia providers. The safety of anesthesia care transitions has not been evaluated. Using unconditional and conditional multivariable logistic regression models, we tested whether the number of attending anesthesiologists involved in an operation was associated with postoperative complications.
  
  
  METHODS
  In a cohort of patients undergoing elective colorectal surgical in an academic tertiary care center with a stable anesthesia care team model participating in the American College of Surgeons National Surgical Quality Improvement Program, using unconditional and conditional multivariable logistic regression models, we tested adjusted associations between numbers of attending anesthesiologists and occurrence of death or a major complication (acute renal failure, bleeding that required a transfusion of 4 units or more of red blood cells within 72 hours after surgery, cardiac arrest requiring cardiopulmonary resuscitation, coma of 24 hours or longer, myocardial infarction, unplanned intubation, ventilator use for 48 hours or more, pneumonia, stroke, wound disruption, deep or organ-space surgical-site infection, superficial surgical-site infection, sepsis, septic shock, systemic inflammatory response syndrome).
  
  
  RESULTS
  We identified 927 patients who underwent elective colectomy of comparable surgical intensity. In all, 71 (7.7%) patients had major nonfatal complications or death. One anesthesiologist provided care for 530 (57%) patients, 2 anesthesiologists for 287 (31%), and 3 or more for 110 (12%). The number of attending anesthesiologists was associated with increased odds of postoperative complication (unadjusted odds ratio [OR] = 1.52, 95% confidence interval [CI] 1.18-1.96, P = 0.0013; adjusted OR = 1.44, 95% CI 1.09-1.91, P = 0.0106). In sensitivity analyses, occurrence of a complication was significantly associated with the number of in-room providers, defined as anesthesia residents and nurse anesthetists (adjusted OR = 1.39, 95% CI 1.01-1.92, P = 0.0446) and for all anesthesia providers (adjusted OR = 1.58, 95%CI 1.20-2.08, P = 0.0012). Findings persisted across multiple, alternative adjustments, sensitivity analyses, and conditional logistic regression with matching on operative duration.
  
  
  CONCLUSIONS
  In our study, care by additional attending anesthesiologists and in-room providers was independently associated with an increased odds of postoperative complications. These findings challenge the assumption that anesthesia transitions are care neutral and not contributory to surgical outcomes.
authors: From the *Division of Critical Care Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; †Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; ‡The Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota; §Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; ‖Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; ¶Department of Surgery, Mayo Clinic, Rochester, Minnesota; #The Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota; and **Department of Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Joseph A
authors: JA
authors: Hyder
authors: J Kyle
authors: JK
authors: Bohman
authors: Daryl J
authors: DJ
authors: Kor
authors: Arun
authors: A
authors: Subramanian
authors: Edward A
authors: EA
authors: Bittner
authors: Bradly J
authors: BJ
authors: Narr
authors: Robert R
authors: RR
authors: Cima
authors: Victor M
authors: VM
authors: Montori
mesh_terms: D000328:Adult; D000368:Aged; D000761:Anesthesia Department, Hospital; D000776:Anesthesiology; D003082:Colectomy / Q000009:adverse effects* / Q000401:mortality; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D008910:Minnesota; D015999:Multivariate Analysis; D016017:Odds Ratio; D010348:Patient Care Team; D062209:Patient Handoff; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers; D000069341:Transitional Care; D016896:Treatment Outcome