title: Attending Handoff Is Correlated with the Decision to Delay Extubation After Surgery.
abstract: BACKGROUND
  Factors including ASA physical status, blood loss, and case length have been described as correlating with the decision to delay tracheal extubation after specific surgical procedures. In this retrospective study, we investigated whether handoffs by anesthesia attendings were associated with delayed extubation after general anesthesia for a broad range of surgical procedures.
  
  
  METHODS
  We reviewed the records of 37,824 patients who underwent general anesthesia with an endotracheal tube for surgery (excluding tracheostomy surgery, cardiac surgeries, and liver and lung transplant surgeries) from 2008 to 2013 at Columbia University Medical Center. Our primary outcome was whether the patient was extubated at the end of the surgical case. We hypothesized that attending handoff was a factor that would independently affect the decision of the anesthesiologist to extubate at the end of the surgical case. In addition, we investigated whether the association between handoff and extubation was affected by the timing of the procedure (ending in the daytime versus evening hours) by including an interaction term in the analysis. We adjusted for other variables affecting the decision to delay extubation.
  
  
  RESULTS
  Patients (5.4%, n = 2033) were not extubated in the operating room after the completion of their surgery. Cases with an attending handoff appeared to have a greater risk of delayed extubation with an adjusted risk ratio (aRR) of 1.14 (95% confidence interval [CI], 1.03-1.25). Further analysis demonstrated that the attending handoff had a significant effect in daytime cases (aRR, 1.62; 95% CI, 1.29-2.04) but not in evening cases (aRR, 1.07; 95% CI, 0.97-1.19).
  
  
  CONCLUSIONS
  Attending handoff was an independent significant factor that increased the risk for the delay of extubation at the end of a surgical case.
authors.affiliation: From the Department of Anesthesiology, Columbia University Medical Center, New York, New York.
authors.forename: Zirka H
authors.initials: ZH
authors.lastname: Anastasian
authors.forename: Minjae
authors.initials: M
authors.lastname: Kim
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Heyer
authors.forename: Shuang
authors.initials: S
authors.lastname: Wang
authors.forename: Mitchell F
authors.initials: MF
authors.lastname: Berman
mesh_terms: D060666:Airway Extubation; D000768:Anesthesia, General; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration; D062209:Patient Handoff / Q000458:organization & administration*; D011182:Postoperative Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome