Intraoperative handover was not consistently linked to worse outcomes

Design

Systematic review with exploratory random-effects meta-analysis (12 cohorts, 1 RCT)

Population

1,030,883 surgical patients; 16.6% with intraoperative handover

Primary outcome

Postoperative morbidity and mortality

Effect

Composite aOR 1.04 (0.98-1.11), I² 72%

This systematic review included 13 studies (12 retrospective cohorts and one multicentre randomised trial) covering 1,030,883 patients, of whom 16.6% had a handover of anaesthesia care during surgery.

The randomised trial found no effect of handover on 30-day mortality, readmission or complications. An exploratory pooled analysis of seven studies (485,623 patients) found no significant association with composite morbidity and mortality (adjusted OR 1.04, 95% CI 0.98-1.11), with high heterogeneity (I² 72%). Sensitivity analyses gave similar results.

Earlier cohort studies raised concern that handovers harm patients, prompting some departments to avoid them at the cost of fatigue. The combined evidence does not show a consistent harm.

Handover quality probably matters more than whether a handover happens, which argues for structured handovers rather than avoiding them.

• Use a structured handover tool covering airway, lines, drugs given, blood loss and the plan.
• Do not delay relief of a fatigued anaesthetist to avoid a handover.
• Hand over at a stable point in the procedure where possible.
• Audit handover quality, not only handover frequency.

Why it matters

It weakens the case for avoiding handovers, which trades one patient-safety risk for another in fatigue.

Don't overread it

Most studies were retrospective with varied definitions and adjustment, so residual confounding could hide a real effect in some settings.

The statistics, in plain English

An I² of 72% means studies disagreed substantially, so a single pooled odds ratio hides a range of settings. The interval of 0.98 to 1.11 excludes a large harm overall but not a small one.

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