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Association between paediatric intraoperative anaesthesia handover and adverse postoperative outcomes
  1. Thomas Kannampallil1,
  2. Daphne Lew2,
  3. Ethan E Pfeifer1,
  4. Anshuman Sharma1,
  5. Joanna Abraham1
  1. 1Department of Anesthesiology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
  2. 2Division of Biostatistics, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
  1. Correspondence to Dr Thomas Kannampallil, Department of Anesthesiology, Washington University School of Medicine in Saint Louis, Saint Louis, MO 63110, USA; thomas.k{at}


Objective To determine whether intraoperative handover of patient care from one anaesthesia clinician to another was associated with an increased risk of adverse postoperative outcomes during paediatric surgeries.

Design, setting and participants A retrospective, population-based cohort study (1 April 2013–1 June 2018) at an academic medical centre.

Exposure Intraoperative handover of care between pairs of anaesthesia clinicians from one care provider to another compared with no handover of anaesthesia care.

Main outcomes and measures The primary outcome was a composite of all-cause mortality and major postoperative morbidity within 30 days after surgery. Secondary outcomes included individual components of the primary outcome and 30-day hospital readmission. Inverse probability of exposure weighting using propensity scores for intraoperative handovers was calculated. Weighted logistic regression was used to determine the association between intraoperative anaesthesia handovers and outcomes.

Results 78 321 paediatric surgical cases (n=5411 with handovers) were included for analysis. Patients were predominantly male (56.5%) with a median age of 6.56 (IQR: 2.65–12.53) years and a median anaesthesia duration of 76 (IQR: 55–126) min. In the weighted sample, the odds of the primary outcome (OR: 0.92; 95% CI 0.75 to 1.13; p=0.43), any morbidity (OR: 0.93; 95% CI 0.75 to 1.16; p=0.515), all-cause mortality (OR: 0.8; 95% CI 0.37 to 1.73; p=0.565) or 30-day readmission following surgery (OR: 0.99; 95% CI 0.84 to 1.18; p=0.95) did not significantly differ among surgeries with and without handovers.

Conclusions Among paediatric patients undergoing surgery, intraoperative anaesthesia handovers were not associated with adverse postoperative outcomes, after accounting for relevant covariates. These findings provide a preliminary perspective on the role of intraoperative handovers as a care-neutral event, with implications for improving safety.

  • Intraoperative handovers
  • handoffs
  • transition of care
  • paediatric
  • surgery
  • safety
  • postoperative outcomes

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  • Contributors TK, EEP, AS and JA conceived the idea and collected the data. TK and DL conducted the analysis. TK, DL and JA interpreted the results. All authors were included in the writing of the manuscript and critically revising it. All authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data for this study include protected health information and are covered by an approved institutional protocol. Currently, no data are available for sharing. With appropriate data use agreements, data can potentially be made available. Please contact the first author for further details.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.