Importance Intraoperative handovers of anesthesia care are common. Handovers might improve care by reducing physician fatigue, but there is also an inherent risk of losing critical information. Large observational analyses report associations between handover of anesthesia care and adverse events, including higher mortality. Objective To determine the effect of handovers of anesthesia care on postoperative morbidity and mortality. Design, Setting, and Participants This was a parallel-group, randomized clinical trial conducted in 12 German centers with patients enrolled between June 2019 and June 2021 (final follow-up, July 31, 2021). Eligible participants had an American Society of Anesthesiologists physical status 3 or 4 and were scheduled for major inpatient surgery expected to last at least 2 hours. Interventions A total of 1817 participants were randomized to receive either a complete handover to receive anesthesia care by another clinician (n = 908) or no handover of anesthesia care (n = 909). None of the participating institutions used a standardized handover protocol. Main Outcomes and Measures The primary outcome was a 30-day composite of all-cause mortality, hospital readmission, or serious postoperative complications. There were 19 secondary outcomes, including the components of the primary composite, along with intensive care unit and hospital lengths of stay. Results Among 1817 randomized patients, 1772 (98%; mean age, 66 [SD, 12] years; 997 men [56%]; and 1717 [97%] with an American Society of Anesthesiologists physical status of 3) completed the trial. The median total duration of anesthesia was 267 minutes (IQR, 206-351 minutes), and the median time from start of anesthesia to first handover was 144 minutes in the handover group (IQR, 105-213 minutes). The composite primary outcome occurred in 268 of 891 patients (30%) in the handover group and in 284 of 881 (33%) in the no handover group (absolute risk difference [RD], -2.5%; 95% CI, -6.8% to 1.9%; odds ratio [OR], 0.89; 95% CI, 0.72 to 1.10; P = .27). Nineteen of 889 patients (2.1%) in the handover group and 30 of 873 (3.4%) in the no handover group experienced all-cause 30-day mortality (absolute RD, -1.3%; 95% CI, -2.8% to 0.2%; OR, 0.61; 95% CI, 0.34 to 1.10; P = .11); 115 of 888 (13%) vs 136 of 872 (16%) were readmitted to the hospital (absolute RD, -2.7%; 95% CI, -5.9% to 0.6%; OR, 0.80; 95% CI, 0.61 to 1.05; P = .12); and 195 of 890 (22%) vs 189 of 874 (22%) experienced serious postoperative complications (absolute RD, 0.3%; 95% CI, -3.6% to 4.1%; odds ratio, 1.02; 95% CI, 0.81 to 1.28; P = .91). None of the 19 prespecified secondary end points differed significantly. Conclusions and Relevance Among adults undergoing extended surgical procedures, there was no significant difference between the patients randomized to receive handover of anesthesia care from one clinician to another, compared with the no handover group, in the composite primary outcome of mortality, readmission, or serious postoperative complications within 30 days. Trial Registration ClinicalTrials.gov Identifier: NCT04016454.

中文翻译：

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麻醉护理的术中交接对成人死亡率、再入院或术后并发症的影响：HandiCAP 随机临床试验。

重要性 麻醉护理的术中交接很常见。交接可以通过减少医生疲劳来改善护理，但也存在丢失关键信息的固有风险。大型观察分析报告了麻醉护理交接与不良事件（包括更高的死亡率）之间的关联。目的 确定麻醉护理交接对术后发病率和死亡率的影响。设计、设置和参与者 这是一项平行组、随机临床试验，在 2019 年 6 月至 2021 年 6 月期间在 12 个德国中心进行了患者入组（最终随访时间为 2021 年 7 月 31 日）。符合条件的参与者的身体状况为美国麻醉师协会 3 级或 4 级，并计划进行预计持续至少 2 小时的大型住院手术。干预 共有 1817 名参与者被随机分配接受完全交接以接受另一名临床医生的麻醉护理 (n = 908) 或不交接麻醉护理 (n = 909)。参与机构均未使用标准化的移交协议。主要结果和测量 主要结果是 30 天的全因死亡率、再入院率或严重术后并发症的综合结果。有 19 个次要结果，包括主要复合的组成部分，以及重症监护病房和住院时间。结果 在 1817 名随机分组的患者中，1772 名（98%；平均年龄 66 [SD，12] 岁；997 名男性 [56%]；1717 名 [97%] 的美国麻醉医师协会身体状况为 3）完成了试验。中位总麻醉时间为 267 分钟（IQR，206-351 分钟），交接组从麻醉开始到首次交接的中位时间为 144 分钟（IQR，105-213 分钟）。交接组 891 名患者中的 268 名 (30%) 和非交接组 881 名患者中的 284 名 (33%) 发生了复合主要结局（绝对风险差 [RD]，-2.5%；95% CI，-6.8 % 至 1.9%；比值比 [OR]，0.89；95% CI，0.72 至 1.10；P = .27）。交接组 889 名患者中的 19 名 (2.1%) 和非交接组 873 名患者中的 30 名 (3.4%) 经历了 30 天全因死亡率（绝对 RD，-1.3%；95% CI，-2.8% 至 0.2 %；OR，0.61；95% CI，0.34 至 1.10；P = .11）；888 人中的 115 人 (13%) 和 872 人中的 136 人 (16%) 再次入院（绝对 RD，-2.7%；95% CI，-5.9% 至 0.6%；OR，0.80；95% CI，0.61 至 1.05 ; P = .12); 890 人中的 195 人 (22%) 和 874 人中的 189 人 (22%) 经历了严重的术后并发症（绝对 RD，0.3%；95% CI，-3.6% 至 4.1%；比值比，1.02；95% CI，0.81 至 1.28 ；P = .91）。19 个预先指定的次要终点均无显着差异。结术后 30 天内出现并发症。试验注册 ClinicalTrials.gov 标识符：NCT04016454。19 个预先指定的次要终点均无显着差异。结术后 30 天内出现并发症。试验注册 ClinicalTrials.gov 标识符：NCT04016454。19 个预先指定的次要终点均无显着差异。结术后 30 天内出现并发症。试验注册 ClinicalTrials.gov 标识符：NCT04016454。或 30 天内出现严重的术后并发症。试验注册 ClinicalTrials.gov 标识符：NCT04016454。或 30 天内出现严重的术后并发症。试验注册 ClinicalTrials.gov 标识符：NCT04016454。