title: Intraoperative Care Transitions Are Not Associated with Postoperative Adverse Outcomes.
abstract: Whether anesthesia care transitions and provision of short breaks affect patient outcomes remains unclear.
  
  
  
  The authors determined the number of anesthesia handovers and breaks during each case for adults admitted between 2005 and 2014, along with age, sex, race, American Society of Anesthesiologists physical status, start time and duration of surgery, and diagnosis and procedure codes. The authors defined a collapsed composite of in-hospital mortality and major morbidities based on primary and secondary diagnoses. The relationship between the total number of anesthesia handovers during a case and the collapsed composite outcome was assessed with a multivariable logistic regression. The relationship between the total number of anesthesia handovers during a case and the components of the composite outcome was assessed using multivariate generalized estimating equation methods. Additionally, the authors analyzed major complications and/or death within 30 days of surgery based on the American College of Surgeons National Surgical Quality Improvement Program-defined events.
  
  
  
  A total of 140,754 anesthetics were identified for the primary analysis. The number of anesthesia handovers was not found to be associated (P = 0.19) with increased odds of postoperative mortality and serious complications, as measured by the collapsed composite, with odds ratio for a one unit increase in handovers of 0.957; 95% CI, 0.895 to 1.022, when controlled for potential confounding variables. A total of 8,404 anesthetics were identified for the NSQIP analysis (collapsed composite odds ratio, 0.868; 95% CI, 0.718 to 1.049 for handovers).
  
  
  
  In the analysis of intraoperative handovers, anesthesia care transitions were not associated with an increased risk of postoperative adverse outcomes.
authors.affiliation: From the Vanderbilt Departments of Anesthesiology (M.A.T., J.M.E., J.P.W.), Biomedical Informatics (J.M.E., J.P.W.), Surgery (J.M.E., O.D.G.), and Health Policy (J.M.E.), Nashville, Tennessee; Anesthesia Quality Institute, Schaumburg, Illinois (R.P.D.); and Quality, Safety and Risk Prevention, Vanderbilt University Medical Center, Nashville, Tennessee (B.J.M.).
authors.forename: Maxim A
authors.initials: MA
authors.lastname: Terekhov
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Ehrenfeld
authors.forename: Richard P
authors.initials: RP
authors.lastname: Dutton
authors.forename: Oscar D
authors.initials: OD
authors.lastname: Guillamondegui
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Martin
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Wanderer
mesh_terms: D000758:Anesthesia / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D062209:Patient Handoff / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology; D000069341:Transitional Care / Q000706:statistics & numerical data*