Association Between Handover of Anesthesia Care and Adverse Postoperative Outcomes Among Patients Undergoing Major Surgery
| Autor: | Richard Cherry, Krista Bray Jenkyn, Britney Allen, Philip M. Jones, Kelly Vogt, Salimah Z. Shariff, Duminda N. Wijeysundera, Suzanne Flier |
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| Rok vydání: | 2018 |
| Předmět: |
Risk
medicine.medical_specialty Population Anesthesia Procedure 03 medical and health sciences 0302 clinical medicine Anesthesiology 030202 anesthesiology Interquartile range Humans Medicine Anesthesia 030212 general & internal medicine education Original Investigation education.field_of_study business.industry Patient Handoff Absolute risk reduction Retrospective cohort study General Medicine Continuity of Patient Care Surgery Cohort Patient Safety business Cohort study |
| Zdroj: | JAMA. 319:143 |
| ISSN: | 0098-7484 |
| DOI: | 10.1001/jama.2017.20040 |
| Popis: | Importance Handing over the care of a patient from one anesthesiologist to another occurs during some surgeries and might increase the risk of adverse outcomes. Objective To assess whether complete handover of intraoperative anesthesia care is associated with higher likelihood of mortality or major complications compared with no handover of care. Design, Setting, and Participants A retrospective population-based cohort study (April 1, 2009-March 31, 2015 set in the Canadian province of Ontario) of adult patients aged 18 years and older undergoing major surgeries expected to last at least 2 hours and requiring a hospital stay of at least 1 night. Exposure Complete intraoperative handover of anesthesia care from one physician anesthesiologist to another compared with no handover of anesthesia care. Main Outcomes and Measures The primary outcome was a composite of all-cause death, hospital readmission, or major postoperative complications, all within 30 postoperative days. Secondary outcomes were the individual components of the primary outcome. Inverse probability of exposure weighting based on the propensity score was used to estimate adjusted exposure effects. Results Of the 313 066 patients in the cohort, 56% were women; the mean (SD) age was 60 (16) years; 49% of surgeries were performed in academic centers; 72% of surgeries were elective; and the median duration of surgery was 182 minutes (interquartile [IQR] range, 124-255). A total of 5941 (1.9%) patients underwent surgery with complete handover of anesthesia care. The percentage of patients undergoing surgery with a handover of anesthesiology care progressively increased each year of the study, reaching 2.9% in 2015. In the unweighted sample, the primary outcome occurred in 44% of the complete handover group compared with 29% of the no handover group. After adjustment, complete handovers were statistically significantly associated with an increased risk of the primary outcome (adjusted risk difference [aRD], 6.8% [95% CI, 4.5% to 9.1%];P Conclusions and Relevance Among adults undergoing major surgery, complete handover of intraoperative anesthesia care compared with no handover was associated with a higher risk of adverse postoperative outcomes. These findings may support limiting complete anesthesia handovers. |
| Databáze: | OpenAIRE |
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