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Attending Handoff Is Correlated with the Decision to Delay Extubation After Surgery

Anastasian, Zirka H. MD; Kim, Minjae MD, MS; Heyer, Eric J. MD, PhD; Wang, Shuang PhD; Berman, Mitchell F. MD, MPH

doi: 10.1213/ANE.0000000000001069
Patient Safety: Research Report

BACKGROUND: Factors including ASA physical status, blood loss, and case length have been described as correlating with the decision to delay tracheal extubation after specific surgical procedures. In this retrospective study, we investigated whether handoffs by anesthesia attendings were associated with delayed extubation after general anesthesia for a broad range of surgical procedures.

METHODS: We reviewed the records of 37,824 patients who underwent general anesthesia with an endotracheal tube for surgery (excluding tracheostomy surgery, cardiac surgeries, and liver and lung transplant surgeries) from 2008 to 2013 at Columbia University Medical Center. Our primary outcome was whether the patient was extubated at the end of the surgical case. We hypothesized that attending handoff was a factor that would independently affect the decision of the anesthesiologist to extubate at the end of the surgical case. In addition, we investigated whether the association between handoff and extubation was affected by the timing of the procedure (ending in the daytime versus evening hours) by including an interaction term in the analysis. We adjusted for other variables affecting the decision to delay extubation.

RESULTS: Patients (5.4%, n = 2033) were not extubated in the operating room after the completion of their surgery. Cases with an attending handoff appeared to have a greater risk of delayed extubation with an adjusted risk ratio (aRR) of 1.14 (95% confidence interval [CI], 1.03–1.25). Further analysis demonstrated that the attending handoff had a significant effect in daytime cases (aRR, 1.62; 95% CI, 1.29–2.04) but not in evening cases (aRR, 1.07; 95% CI, 0.97–1.19).

CONCLUSIONS: Attending handoff was an independent significant factor that increased the risk for the delay of extubation at the end of a surgical case.

Supplemental Digital Content is available in the text.Published ahead of print December 8, 2015

From the Department of Anesthesiology, Columbia University Medical Center, New York, New York.

Accepted for publication September 15, 2015.

Published ahead of print December 8, 2015

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Drs. Anastasian and Kim are co-first authors.

This report was previously presented, in part, at the American Society of Anesthesiologists meeting, October 25, 2015, in New Orleans, LA.

Reprints will not be available from the authors.

Address correspondence to Zirka H. Anastasian, MD, Department of Anesthesiology, Columbia University Medical Center, 622 West 168th St., PH 5–523, New York, NY 10032. Address e-mail to

© 2016 International Anesthesia Research Society
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