Handover anesthesia care does not impact mortality or postoperative complications: JAMA

Germany: There is no significant difference between handover of anesthesia care versus no handover of care in the risk of postoperative morbidity and mortality, a recent study has found.

According to the study, there was no significant readmission, mortality, or serious postoperative complications within 30 days in patients who received handover of anesthesia care from one clinician to another versus no handover group, among the adults undergoing extended surgical procedures.

Anesthesia care is frequently handed over intraoperatively. Handovers may enhance treatment by lowering physician tiredness, but there is also the danger of vital information being lost. Large observational studies show links between anesthetic care handover and adverse outcomes, including increased mortality. Melanie Meersch and colleagues conducted this study to assess the effect of anesthetic care handovers on postoperative morbidity and mortality.

This was a randomized, parallel-group clinical study that took place at 12 German centers between June 2019 and June 2021. (final follow-up, July 31, 2021). Participants were eligible if they had an American Society of Anesthesiologists physical status of 3 or 4 and were scheduled for major inpatient surgery lasting at least 2 hours.

A total of 1817 individuals were randomly assigned to either a complete handover to another physician for anesthesia treatment (n = 908) or no transfer of anesthesia care (n = 909). There was no common handover mechanism employed by any of the collaborating universities. The primary goal was to achieve a 30-day composite of all-cause mortality, hospital readmission, or significant postoperative complications. There were 19 secondary events, which included the basic composite components as well as critical care unit and hospital duration of stay.

The key findings of this study were as follows:

1. The experiment was completed by 1772 of 1817 randomly selected individuals.

2. In the handover group, the median total length of anesthesia was 267 minutes, and the median time from commencement of anesthesia to the first handover was 144 minutes.

3. The aggregate primary outcome happened in 268 of 891 patients (30% of the handover group) and 284 of 881 (33%) in the no handover group.

4. All-cause 30-day mortality occurred in 19 of 889 patients (2.1%) in the handover group and 30 of 873 (3.4%) in the no handover group; 115 of 888 (13%) vs 136 of 872 (16%) were readmitted to the hospital; and 195 of 890 (22%) vs 189 of 874 (22%) experienced serious postoperative complications.

5. None of the 19 secondary endpoints were substantially different.

Reference:

Meersch, M., Weiss, R., Küllmar, M., Bergmann, L., Thompson, A., Griep, L., Kusmierz, D., Buchholz, A., Wolf, A., Nowak, H., Rahmel, T., Adamzik, M., Haaker, J. G., … Zarbock, A. (2022). Effect of Intraoperative Handovers of Anesthesia Care on Mortality, Readmission, or Postoperative Complications Among Adults. In JAMA. American Medical Association (AMA). https://doi.org/10.1001/jama.2022.9451