Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD.
Surgery. 2024 Nov;176(5):1450-1457. doi: 10.1016/j.surg.2024.07.042. Epub 2024 Aug 27.
Anesthesiologists transition patient care to combat clinician fatigue and accommodate shift limitations. Studies exploring the association of increased handovers with patient outcomes have conflicting findings. Here, we investigate the association of anesthesia handovers with perioperative outcomes in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
Patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at a single institution from 2017 to 2022 were stratified by the number of anesthesia attending and nonattending (nurse anesthetist/resident) handovers (0-1 or ≥2). Primary outcomes were intensive care unit and hospital length of stay, in addition to 30-day serious morbidity. Logistic and negative binomial regression models were adjusted for covariates related to patient and case complexity.
A total of 182 patients were included. Median operative time was 720 minutes (interquartile range, 540-900 minutes). Most cases had fewer than 2 attending handovers (n = 147, 81% vs ≥2 handovers n = 35, 19%) and 2 nonattending handovers (n = 120, 71% vs ≥2 handovers n = 53, 29%). In adjusted models, there were no differences in 30-day serious morbidity and intensive care unit or hospital length of stay between the attending handover groups (0-1 vs ≥2). Patients with ≥2 non-attending handovers had similar odds of 30-day serious morbidity compared with the 0-1 group (odds ratio, 1.613, 95% confidence interval, 0.733-3.550, P = .235), but a longer total hospital (incidence rate ratio, 1.301, 95% confidence interval, 1.071-1.579, P = .008) and intensive care unit length of stay (incidence rate ratio 1.548, 95% confidence interval, 1.038-2.049, P = .030).
Multiple anesthesia handovers were not associated with an increased risk of serious morbidity for patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. However, increased handovers (≥2) between nonattending providers was associated with longer hospital and intensive care unit length of stays.
麻醉师通过交接班来转换患者的护理工作，以应对临床医生的疲劳和班次限制。探索交接班次数增加与患者结局之间关联的研究结果存在差异。在此，我们研究了在接受细胞减灭术和腹腔内热灌注化疗的患者中，麻醉交接班与围手术期结局之间的关联。
在一家机构接受细胞减灭术和腹腔内热灌注化疗的患者，根据麻醉主治医生和非主治医生（麻醉护士/住院医师）的交接班次数（0-1 次或≥2 次）进行分层。主要结局是重症监护病房和医院的住院时间，以及 30 天严重发病率。使用与患者和病例复杂性相关的协变量调整了逻辑和负二项回归模型。
共纳入 182 例患者。中位手术时间为 720 分钟（四分位距 540-900 分钟）。大多数病例的主治医生交接班次数少于 2 次（n=147，81% vs ≥2 次交接 n=35，19%）和非主治医生交接班次数 2 次（n=120，71% vs ≥2 次交接 n=53，29%）。在调整模型中，0-1 次主治医生交接班组和≥2 次主治医生交接班组在 30 天严重发病率和重症监护病房或医院住院时间方面无差异。与 0-1 次非主治医生交接班组相比，≥2 次非主治医生交接班组患者的 30 天严重发病率的比值比为 1.613（95%置信区间，0.733-3.550，P=0.235），但总住院时间（发病率比，1.301，95%置信区间，1.071-1.579，P=0.008）和重症监护病房住院时间（发病率比，1.548，95%置信区间，1.038-2.049，P=0.030）较长。
对于接受细胞减灭术和腹腔内热灌注化疗的患者，多次麻醉交接班与严重发病率增加无关。然而，非主治医生之间的交接次数增加（≥2 次）与住院时间和重症监护病房住院时间延长有关。
