34
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: not found
      • Article: not found

      Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade and Postoperative Pulmonary Complications (STRONGER) : A Multicenter Matched Cohort Analysis

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          5% of adult patients undergoing noncardiac inpatient surgery experience a major pulmonary complication. We hypothesized that the choice of neuromuscular blockade reversal (neostigmine versus sugammadex) may be associated with a lower incidence of major pulmonary complications. Twelve US Multicenter Perioperative Outcomes Group hospitals were included in a multicenter observational matched-cohort study of surgical cases between January 2014 and August 2018. Adult patients undergoing elective inpatient non-cardiac surgical procedures with general anesthesia and endotracheal intubation receiving a non-depolarizing neuromuscular blockade agent and reversal were included. Exact matching criteria included institution, sex, age, comorbidities, obesity, surgical procedure type, and neuromuscular blockade reversal agent (rocuronium versus vecuronium). Other preoperative and intraoperative factors were compared and adjusted in the case of residual imbalance. The composite primary outcome was major postoperative pulmonary complications, defined as pneumonia, respiratory failure, or other pulmonary complications (including pneumonitis; pulmonary congestion; iatrogenic pulmonary embolism, infarction, or pneumothorax). Secondary outcomes focused on the components of pneumonia and respiratory failure. Of 30,026 patients receiving sugammadex, 22,856 were matched to 22,856 patients receiving neostigmine. Out of 45,712 patients studied, 1,892 (4.1%) were diagnosed with the composite primary outcome (3.5% sugammadex vs 4.8% neostigmine). 796 (1.7%) patients had pneumonia (1.3% vs 2.2%), and 582 (1.3%) respiratory failure (0.8% vs 1.7%). In multivariable analysis, sugammadex administration was associated with a 30% reduced risk of pulmonary complications (adjusted odds ratio 0.70, 95% confidence interval 0.63 to 0.77), 47% reduced risk of pneumonia (0.53, 0.44 to 0.62), and 55% reduced risk of respiratory failure (0.45, 0.37 to 0.56), compared to neostigmine. Among a generalizable cohort of adult patients undergoing inpatient surgery at US hospitals, the use of sugammadex was associated with a clinically and statistically significant lower incidence of major pulmonary complications. Among more than 45,000 patients undergoing inpatient noncardiac surgery across 12 US hospitals, the administration of sugammadex compared to neostigmine is associated with a 30% lower risk of major pulmonary complications

          Related collections

          Most cited references22

          • Record: found
          • Abstract: found
          • Article: not found

          Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program.

          The National Surgical Quality Improvement Project (NSQIP) has reduced morbidity rates in Veterans Affairs Hospitals. As the NSQIP methods move to private-sector hospitals, funding responsibilities will shift to the medical center. The objective of the current study was to calculate hospital costs associated with postoperative complications, because reducing morbidity may offset the costs of using the NSQIP. Patient data were obtained from a single private-sector center involved in the NSQIP from 2001 to 2002 (n=1,008). Cost data were derived from the hospital's internal cost-accounting database (TSI; Transitions Systems Inc). Total hospital costs associated with both minor complications and major complications were calculated. Multiple linear regression was used to determine the cost of each type of complication after adjusting for patient characteristics. Rates of minor complications (6.3%, 64 events) and major complications (6.6%, 67 events) were similar. Median hospital costs were lowest for patients without complications (4,487 dollars) compared with those with minor (14,094 dollars) and major complications (28,356 dollars) (p<0.001). After adjusting for differences in patient characteristics, major complications were associated with an increase of 11,626 dollars (95% CI, 9,419 dollars to 13,832 dollars; p<0.001). Minor complications were not associated with increased costs in the adjusted analysis. Given the substantial costs associated with major postoperative complications, reducing morbidity may provide sufficient cost savings to offset the resources needed to participate in the private-sector expansion of the NSQIP.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Global burden of postoperative death

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

              Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications.
                Bookmark

                Author and article information

                Journal
                Anesthesiology
                Anesthesiology
                Ovid Technologies (Wolters Kluwer Health)
                0003-3022
                2020
                June 2020
                : 132
                : 6
                : 1371-1381
                Article
                10.1097/ALN.0000000000003256
                7864000
                32282427
                47177458-a703-42d9-adfc-610ed2cbbf00
                © 2020
                History

                Comments

                Comment on this article