Intraoperative anesthesia handovers are associated with increased risk of mortality and morbidity in surgical patientsAnesthesia handovers during surgery are linked to higher patient risks

Frontiers in Medicine Published June 12, 2026 Study authors: Congcong Zou, Hongyang Chen, Weiyi Zhang DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Note that intraoperative anesthesia handovers are associated with significantly higher risks of mortality and morbidity.

This systematic review and meta-analysis analyzed 14 studies to evaluate the impact of intraoperative anesthesia handovers on patient outcomes in surgical settings. The analysis focused on primary outcomes of mortality and morbidity, alongside secondary outcomes including ICU stay duration and emergency department visits.

The meta-analysis revealed a significant association between intraoperative handovers and increased risk across several metrics. Specifically, the adjusted relative risk (aRR) for composite in-hospital mortality and morbidity was 1.44 (95% CI 1.23–1.69). In-hospital mortality showed an aRR of 1.49 (95% CI 1.15–1.91), while morbidity showed an aRR of 1.35 (95% CI 1.18–1.54). Additionally, patients experienced longer ICU stays (aRR 1.33; 95% CI 1.23–1.44) and more emergency department visits within 90 days (aRR 1.08; 95% CI 1.06–1.11). Readmission within 30 days did not show a statistically significant association.

A notable limitation of the study is the high heterogeneity observed in several outcomes, with I2 values reaching up to 98.0%. While the data indicate an association between handovers and adverse events, this was not modified by surgical severity or specific handover levels. These findings suggest that while intraoperative handovers are linked to increased risks, further research is required to identify specific handover characteristics that impact patient safety.

When a surgical team changes who is managing a patient's anesthesia during an operation, it can create significant risks. A review of 14 studies found that these handovers are associated with a higher risk of both mortality and morbidity, which refers to any physical condition or injury resulting from the medical treatment.

Specifically, patients who experienced these transitions were more likely to face complications and spend more time in the intensive care unit. The data also showed an increased risk of visiting the emergency department within 90 days of surgery. While the study did not find a significant link to hospital readmissions within 30 days, the other risks remained clear.

It is important to note that these findings show an association rather than direct cause and effect. The researchers also noted high variation in how different studies reported these outcomes. More research is still needed to figure out which specific parts of the handover process make it safer or riskier for patients.

What this means for you:

Anesthesia handovers during surgery are linked to higher risks of complications and longer intensive care stays.

Common questions

What specific risks are linked to anesthesia handovers?

The study found that intraoperative anesthesia handovers were significantly associated with higher rates of mortality and morbidity. Patients also faced a higher risk of staying in the intensive care unit for longer periods and visiting the emergency department within 90 days after surgery.

Does an anesthesia handover increase the chance of being readmitted?

The data did not show a significant association between anesthesia handovers and hospital readmissions within 30 days. While other risks like morbidity and longer intensive care stays were linked to these transitions, the risk of early readmission was not significantly different.

Does the severity of the surgery change the risk of a handover?

The study found that the association between anesthesia handovers and adverse outcomes was not changed by the severity of the surgery or the specific level of the handover. This means the risk remained consistent regardless of how difficult the procedure was.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

Intraoperative anesthesia handover is a common occurrence; however, limited research has explored its impact on patient outcomes. The purpose of this systematic review and meta-analysis was to assess the effects of anesthesia handovers on adverse outcomes in surgical settings. All clinical studies that specifically investigated the association between anesthesia handovers and adverse patient outcomes were included. The MEDLINE, Cochrane Library trials, PubMed, Embase, and Web of Science databases were searched from inception to June 15, 2025. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Using STATA and R statistical software, exploratory and cumulative meta-analyses were conducted using a random-effects model for adjusted ratio risks (aRR) with 95% confidence intervals [95% CI]. Subgroup and sensitivity analyses were also performed given potential heterogeneity. Meta-analyses of 14 studies revealed a significant association between anesthesia handovers and several adverse outcomes, including composite in-hospital mortality and morbidity (aRR = 1.44, 95% CI 1.23–1.69, I2 = 97.6%), in-hospital mortality (aRR = 1.49, 95% CI 1.15–1.91, I2 = 95.5%), morbidity (aRR = 1.35, 95% CI 1.18–1.54, I2 = 98.0%), length of intensive care unit (ICU) stay (aRR = 1.33, 95% CI 1.23–1.44, I2 = 82.3%), and the number of emergency department visits within 90 days of index surgery (aRR = 1.08, 95% CI 1.06–1.11, I2 = 0.0%), whereas only a non-significant association was observed for readmission within 30 days (aRR = 1.09, 95% CI 0.97–1.22, I2 = 91.9%). Furthermore, subgroup analyses indicated that the association between anesthesia handover and adverse outcomes was not modified by either surgical severity or a specific level of anesthesia handover. Intraoperative anesthesia handovers are generally associated with an increased risk of mortality and morbidity in surgical patients. Future research should prioritize identifying the specific characteristics of anesthesia handovers that affect patient safety. https://www.crd.york.ac.uk/prospero/, identifier: CRD420251140062.

Intraoperative anesthesia handovers are associated with increased risk of mortality and morbidity in surgical patientsAnesthesia handovers during surgery are linked to higher patient risks

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Intraoperative anesthesia handovers are associated with increased risk of mortality and morbidity in surgical patientsAnesthesia handovers during surgery are linked to higher patient risks

Common questions

Study Details

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