HandiCAP
Trial question
What is the effect of intraoperative handovers of anesthesia care in adults undergoing extended surgical procedures?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
44.0% female
56.0% male
N = 1772
1772 patients (775 female, 997 male).
Inclusion criteria: adult patients scheduled for major inpatient surgery expected to last at least 2 hours.
Key exclusion criteria: pregnancy; previous surgery by the same specialty within 6 months; participation in another interventional trial within the last 3 months.
Interventions
N=891 handover of care (at least one complete transition of care from 1 anesthesiologist to another during surgery).
N=881 no handover of care (same anesthesiologist from anesthesia induction to end of surgical procedure).
Primary outcome
Composite of death, hospital readmission, or serious postoperative complications at day 30
30.1%
32.5%
32.5 %
24.4 %
16.3 %
8.1 %
0.0 %
Handover of
care
No handover of
care
No significant
difference ↔
No significant difference in death, hospital readmission, or serious postoperative complications at day 30 (30.1% vs. 32.5%; OR 0.89, 95% CI 0.72 to 1.1).
Secondary outcomes
No significant difference in all-cause mortality at day 30 (2.1% vs. 3.4%; OR 0.61, 95% CI 0.34 to 1.1).
No significant difference in hospital readmission at day 30 (13% vs. 15.6%; OR 0.8, 95% CI 0.61 to 1.05).
No significant difference in the rate of serious postoperative complications within 30 days (21.9% vs. 21.6%; OR 1.02, 95% CI 0.81 to 1.28).
Conclusion
In adult patients scheduled for major inpatient surgery expected to last at least 2 hours, handover of care was not superior to no handover of care with respect to the composite of death, hospital readmission, or serious postoperative complications at day 30.
Reference
Melanie Meersch, Raphael Weiss, Mira Küllmar et al. Effect of Intraoperative Handovers of Anesthesia Care on Mortality, Readmission, or Postoperative Complications Among Adults: The HandiCAP Randomized Clinical Trial. JAMA. 2022 Jun 28;327(24):2403-2412.
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