When patients under anesthesia are handed off from one doctor to another, there is a higher rate of complications and deaths, according to the findings of new research.
It is common for anesthesiologists to “handover” a patient to another anesthesiologist mid-surgery. However, a study published this week in the Journal of the American Medical Association (JAMA) highlights the potentially serious risks that may be associated with the practice.
Researchers studied more than 313,000 adults undergoing major surgery in Ontario, Canada from April 1, 2009, to March 31, 2015. Patients underwent a major surgery which was expected to last two hours, but on average lasted 182 minutes, and required a hospital stay of at least one night.
On average, patients were 60 years old and approximately half of the surgeries were performed in academic hospital centers. More than 70% of surgeries were elective.
Researchers compared complete intraoperative handover of anesthesia care to no handover of anesthesia care. They found the percentage of handovers increased each year. The rate began at 1.9%, or roughly 5,900 patients, in 2009 and reached 2.9% by 2015.
The increase in the frequency of handovers may be related to new policies concerning shift hours and fatigue during surgery. Some hospitals may have implemented policies concerning these issues, which has resulted in increased handovers.
Overall, handovers of anesthesia care were significantly associated with a higher risk of all-cause death and major postoperative complications within 30 days after surgery. Nearly 45% of the anesthesia handover group experienced complications. That compares to complications among only 29% of the group that did not experience an anesthesia handover.
While anesthesia handovers were linked to higher rates of death and major complications, it was not associated with hospital readmission within 30 days of the initial surgery.
“These findings may support limiting complete anesthesia handovers,” warned study authors.
Researchers speculated the problem was related to poor communication between anesthesiologists. Having specific and familiar tools and checklists in place for handovers may help reduce the rate of complications.