Effect of Intraoperative Handovers of Anesthesia Care on Mortality, Readmission, or Postoperative Complications Among Adults: The HandiCAP Randomized Clinical Trial

• Published in: JAMA : the journal of the American Medical Association 2022-06, Vol.327 (24), p.2403-2412
• Main Authors: Meersch, Melanie, Weiss, Raphael, Küllmar, Mira, Bergmann, Lars, Thompson, Astrid, Griep, Leonore, Kusmierz, Desiree, Buchholz, Annika, Wolf, Alexander, Nowak, Hartmuth, Rahmel, Tim, Adamzik, Michael, Haaker, Jan Gerrit, Goettker, Carina, Gruendel, Matthias, Hemping-Bovenkerk, Andre, Goebel, Ulrich, Braumann, Julius, Wisudanto, Irawan, Wenk, Manuel, Flores-Bergmann, Darius, Böhmer, Andreas, Cleophas, Sebastian, Hohn, Andreas, Houben, Anne, Ellerkmann, Richard K, Larmann, Jan, Sander, Julia, Weigand, Markus A, Eick, Nicolas, Ziemann, Sebastian, Bormann, Eike, Gerß, Joachim, Sessler, Daniel I, Wempe, Carola, Massoth, Christina, Zarbock, Alexander
• Format: Article
• Language: English
• Subjects: Adults; Anesthesia; Clinical trials; Comments; Complications; Medical personnel; Morbidity; Mortality; Online First; Original Investigation; Patients; Postoperative
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2022.9451

IMPORTANCE: Intraoperative handovers of anesthesia care are common. Handovers might improve care by reducing physician fatigue, but there is also an inherent risk of losing critical information. Large observational analyses report associations between handover of anesthesia care and adverse events, including higher mortality. OBJECTIVE: To determine the effect of handovers of anesthesia care on postoperative morbidity and mortality. DESIGN, SETTING, AND PARTICIPANTS: This was a parallel-group, randomized clinical trial conducted in 12 German centers with patients enrolled between June 2019 and June 2021 (final follow-up, July 31, 2021). Eligible participants had an American Society of Anesthesiologists physical status 3 or 4 and were scheduled for major inpatient surgery expected to last at least 2 hours. INTERVENTIONS: A total of 1817 participants were randomized to receive either a complete handover to receive anesthesia care by another clinician (n = 908) or no handover of anesthesia care (n = 909). None of the participating institutions used a standardized handover protocol. MAIN OUTCOMES AND MEASURES: The primary outcome was a 30-day composite of all-cause mortality, hospital readmission, or serious postoperative complications. There were 19 secondary outcomes, including the components of the primary composite, along with intensive care unit and hospital lengths of stay. RESULTS: Among 1817 randomized patients, 1772 (98%; mean age, 66 [SD, 12] years; 997 men [56%]; and 1717 [97%] with an American Society of Anesthesiologists physical status of 3) completed the trial. The median total duration of anesthesia was 267 minutes (IQR, 206-351 minutes), and the median time from start of anesthesia to first handover was 144 minutes in the handover group (IQR, 105-213 minutes). The composite primary outcome occurred in 268 of 891 patients (30%) in the handover group and in 284 of 881 (33%) in the no handover group (absolute risk difference [RD], −2.5%; 95% CI, −6.8% to 1.9%; odds ratio [OR], 0.89; 95% CI, 0.72 to 1.10; P = .27). Nineteen of 889 patients (2.1%) in the handover group and 30 of 873 (3.4%) in the no handover group experienced all-cause 30-day mortality (absolute RD, −1.3%; 95% CI, −2.8% to 0.2%; OR, 0.61; 95% CI, 0.34 to 1.10; P = .11); 115 of 888 (13%) vs 136 of 872 (16%) were readmitted to the hospital (absolute RD, −2.7%; 95% CI, −5.9% to 0.6%; OR, 0.80; 95% CI, 0.61 to 1.05; P = .12); and 195 of 890 (22%) vs 189 of 874 (22%) experienced serious