Does intraoperative anesthesia handovers associated with adverse outcomes? A systematic review and meta-analysis

Background 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. Methods 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. Results 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, I 2 = 97.6%), in-hospital mortality (aRR = 1.49, 95% CI 1.15–1.91, I 2 = 95.5%), morbidity (aRR = 1.35, 95% CI 1.18–1.54, I 2 = 98.0%), length of intensive care unit (ICU) stay (aRR = 1.33, 95% CI 1.23–1.44, I 2 = 82.3%), and the number of emergency department visits within 90 days of index surgery (aRR = 1.08, 95% CI 1.06–1.11, I 2 = 0.0%), whereas only a non-significant association was observed for readmission within 30 days (aRR = 1.09, 95% CI 0.97–1.22, I 2 = 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. Conclusions 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. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier: CRD420251140062.