Impact of anesthetic handover on mortality and morbidity in cardiac surgery: a cohort study

Abstract

Objective: Clinical handover is a critical moment in patient care. The authors tested the hypothesis that handover of anesthesia care is associated with increased mortality and morbidity in patients undergoing cardiac surgery.

Design: This was a single-center, retrospective cohort study of prospectively collected data.

Setting: The study was conducted in a quaternary care cardiac surgery center and university research hospital.

Participants: All patients undergoing cardiac surgical procedures between April 1, 1999 and October 31, 2009 were included in the study.

Interventions: Propensity-score matching was used to adjust for differences between patients who received intraoperative handover of anesthesia care and those who did not, and in-hospital mortality and morbidity were compared using multivariate logistic modeling.

Measurements and main results: 14,421 patients met the inclusion criteria for this study; handover occurred in 966 cases (6.7%). After propensity-score matching, 7,137 patients were included for analysis. In-hospital mortality was 5.4% in the handover group and 4.0% in the non-handover group (match-adjusted odds ratio, 1.425; 95% confidence interval, 1.013-2.006; p = 0.0422); the incidence of major morbidity was 18.5% in the handover group and 15.6% in the non-handover group (match-adjusted odds ratio, 1.274; 95% confidence interval, 1.037-1.564; p = 0.0212).

Conclusions: Handover of anesthetic care during cardiac surgery is associated with a 43% greater risk of in-hospital mortality and 27% greater risk of major morbidity. Further studies are required to explore this relationship and to systematically evaluate and improve the process of handover.

Keywords: anesthesiology; cardiac surgery; handover; patient safety.