Universität zu Köln

Meersch, Melanie, Weiss, Raphael, Kuellmar, Mira, Bergmann, Lars, Thompson, Astrid, Griep, Leonore, Kusmierz, Desiree, Buchholz, Annika, Wolf, Alexander ORCID: 0000-0001-8875-586X, Nowak, Hartmuth, Rahmel, Tim, Adamzik, Michael, Haaker, Jan Gerrit, Goettker, Carina, Gruendel, Matthias, Hemping-Bovenkerk, Andre, Goebel, Ulrich, Braumann, Julius, Wisudanto, Irawan, Wenk, Manuel ORCID: 0000-0001-7978-1978, Flores-Bergmann, Darius, Boehmer, Andreas, Cleophas, Sebastian, Hohn, Andreas, Houben, Anne, Ellerkmann, Richard K., Larmann, Jan, Sander, Julia, Weigand, Markus A., Eick, Nicolas, Ziemann, Sebastian ORCID: 0000-0003-4485-6030, Bormann, Eike, Gerss, Joachim, Sessler, Daniel, I, Wempe, Carola, Massoth, Christina and Zarbock, Alexander (2022). Effect of Intraoperative Handovers of Anesthesia Care on Mortality, Readmission, or Postoperative Complications Among Adults The HandiCAP Randomized Clinical Trial. JAMA-J. Am. Med. Assoc., 327 (24). S. 2403 - 2413. CHICAGO: AMER MEDICAL ASSOC. ISSN 1538-3598

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Abstract

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 postoperative complications (absolute RD, 0.3%; 95% CI, -3.6% to 4.1%; odds ratio, 1.02; 95% CI, 0.81 to 128; P = .91). None of the 19 prespecified secondary end points differed significantly. CONCLUSIONS AND RELEVANCE Among adults undergoing extended surgical procedures, there was no significant difference between the patients randomized to receive handover of anesthesia care from one clinician to another, compared with the no handover group, in the composite primary outcome of mortality, readmission, or serious postoperative complications within 30 days.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Meersch, Melanie UNSPECIFIED UNSPECIFIED UNSPECIFIED Weiss, Raphael UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuellmar, Mira UNSPECIFIED UNSPECIFIED UNSPECIFIED Bergmann, Lars UNSPECIFIED UNSPECIFIED UNSPECIFIED Thompson, Astrid UNSPECIFIED UNSPECIFIED UNSPECIFIED Griep, Leonore UNSPECIFIED UNSPECIFIED UNSPECIFIED Kusmierz, Desiree UNSPECIFIED UNSPECIFIED UNSPECIFIED Buchholz, Annika UNSPECIFIED UNSPECIFIED UNSPECIFIED Wolf, Alexander UNSPECIFIED orcid.org/0000-0001-8875-586X UNSPECIFIED Nowak, Hartmuth UNSPECIFIED UNSPECIFIED UNSPECIFIED Rahmel, Tim UNSPECIFIED UNSPECIFIED UNSPECIFIED Adamzik, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Haaker, Jan Gerrit UNSPECIFIED UNSPECIFIED UNSPECIFIED Goettker, Carina UNSPECIFIED UNSPECIFIED UNSPECIFIED Gruendel, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Hemping-Bovenkerk, Andre UNSPECIFIED UNSPECIFIED UNSPECIFIED Goebel, Ulrich UNSPECIFIED UNSPECIFIED UNSPECIFIED Braumann, Julius UNSPECIFIED UNSPECIFIED UNSPECIFIED Wisudanto, Irawan UNSPECIFIED UNSPECIFIED UNSPECIFIED Wenk, Manuel UNSPECIFIED orcid.org/0000-0001-7978-1978 UNSPECIFIED Flores-Bergmann, Darius UNSPECIFIED UNSPECIFIED UNSPECIFIED Boehmer, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Cleophas, Sebastian UNSPECIFIED UNSPECIFIED UNSPECIFIED Hohn, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Houben, Anne UNSPECIFIED UNSPECIFIED UNSPECIFIED Ellerkmann, Richard K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Larmann, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Sander, Julia UNSPECIFIED UNSPECIFIED UNSPECIFIED Weigand, Markus A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Eick, Nicolas UNSPECIFIED UNSPECIFIED UNSPECIFIED Ziemann, Sebastian UNSPECIFIED orcid.org/0000-0003-4485-6030 UNSPECIFIED Bormann, Eike UNSPECIFIED UNSPECIFIED UNSPECIFIED Gerss, Joachim UNSPECIFIED UNSPECIFIED UNSPECIFIED Sessler, Daniel, I UNSPECIFIED UNSPECIFIED UNSPECIFIED Wempe, Carola UNSPECIFIED UNSPECIFIED UNSPECIFIED Massoth, Christina UNSPECIFIED UNSPECIFIED UNSPECIFIED Zarbock, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-692777
DOI:	10.1001/jama.2022.9451
Journal or Publication Title:	JAMA-J. Am. Med. Assoc.
Volume:	327
Number:	24
Page Range:	S. 2403 - 2413
Date:	2022
Publisher:	AMER MEDICAL ASSOC
Place of Publication:	CHICAGO
ISSN:	1538-3598
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CARDIAC-SURGERY; COMMUNICATION; TRANSITIONS; ASSOCIATION; IMPLEMENTATION; MORBIDITY; OUTCOMES; HEALTH; RISK Multiple languages Medicine, General & Internal Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/69277