Impact of intraoperative anesthesia handover on major adverse cardiovascular events after thoracic surgery: A propensity-score matched retrospective cohort study

Abstract

Study objective

Handover of anesthesia care is often required in busy clinical settings. Herein, we investigated whether intraoperative anesthesia handover was associated with an increased risk of major adverse cardiovascular events (MACEs) after thoracic surgery.

Design

A retrospective cohort study.

Setting

A tertiary hospital.

Patients

Adult patients who underwent elective thoracic surgery.

Exposures

A complete handover of intraoperative anesthesia care was defined when the outgoing anesthesiologist transferred patient care to the incoming anesthesiologist and no longer returned.

Measurements

Our primary endpoint was a composite of MACEs, including acute myocardial infarction, new-onset congestive heart failure, non-fatal cardiac arrest, and cardiac death, that occurred within 7 days after surgery. The impact of complete anesthesia handover on postoperative MACEs was analyzed using propensity score matching.

Main results

Of 6962 patients (mean age 59.7 years; 57.4 % female) included in the analysis, 2319 (33.3 %) surgeries were conducted with anesthesia handover whereas 4643 (66.7 %) were conducted without. After propensity score matching, 2165 (50.0 %) surgeries were conducted with anesthesia handover whereas the other half were conducted without. Patients with anesthesia handover developed more MACEs when compared with those without (10.4 % [225/2165] vs. 8.4 % [181/2165]; relative risk 1.24, 95 % CI 1.03 to 1.50, P = 0.022). Specifically, myocardial infarction was more common in patients with anesthesia handover than in those without (9.2 % [199/2165] vs. 7.4 % [160/2165]; relative risk 1.24, 95 % CI 1.02 to 1.52, P = 0.032).

Conclusions

For adult patients undergoing thoracic surgery, a complete handover of intraoperative anesthesia care was associated with an increased risk of MACEs after surgery.