Department of Anesthesiology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
Division of Biostatistics, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA.
BMJ Qual Saf. 2021 Sep;30(9):755-763. doi: 10.1136/bmjqs-2020-012298. Epub 2020 Dec 7.
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.
Intraoperative handover of care between pairs of anaesthesia clinicians from one care provider to another compared with no handover of anaesthesia care.
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.
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.
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.
确定在小儿外科手术中，麻醉医师之间的术中交接是否会增加术后不良结局的风险。
设计、设置和参与者：一项回顾性、基于人群的队列研究（2013 年 4 月 1 日至 2018 年 6 月 1 日）在一家学术医疗中心进行。
麻醉医师之间的术中交接（与一名医护人员相比）。
主要结果是手术 30 天内所有原因死亡和主要术后并发症的综合结果。次要结果包括主要结果的单个组成部分和 30 天的医院再入院。使用倾向评分对术中交接进行逆概率暴露加权。使用加权逻辑回归确定术中麻醉交接与结局之间的关联。
共纳入 78321 例小儿外科手术（5411 例有交接）进行分析。患者主要为男性（56.5%），中位年龄为 6.56 岁（IQR：2.65-12.53 岁），中位麻醉时间为 76 分钟（IQR：55-126 分钟）。在加权样本中，主要结局（OR：0.92；95%CI 0.75 至 1.13；p=0.43）、任何发病率（OR：0.93；95%CI 0.75 至 1.16；p=0.515）、全因死亡率（OR：0.8；95%CI 0.37 至 1.73；p=0.565）或术后 30 天再入院（OR：0.99；95%CI 0.84 至 1.18；p=0.95）的手术在有无交接之间无显著差异。
在接受手术的小儿患者中，考虑到相关协变量后，术中交接与术后不良结局无关。这些发现初步表明术中交接是一种中立的护理事件，对提高安全性具有重要意义。
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