Retrospective analysis of 30-day unplanned readmission after major abdominal surgery with reversal by sugammadex or neostigmine.
Abdomen
/ surgery
Adult
Aged
Aged, 80 and over
Anesthesia Recovery Period
Cholinesterase Inhibitors
/ administration & dosage
Female
Hospital Charges
/ statistics & numerical data
Humans
Length of Stay
/ statistics & numerical data
Male
Middle Aged
Neostigmine
/ administration & dosage
Patient Readmission
/ statistics & numerical data
Retrospective Studies
Sugammadex
/ administration & dosage
Young Adult
anticholinesterase
hospital readmission
length of stay
neuromuscular blocking agents
postoperative complications
reversal agents
rocuronium
Journal
British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
received:
18
06
2018
revised:
30
10
2018
accepted:
13
11
2018
entrez:
17
2
2019
pubmed:
17
2
2019
medline:
23
4
2019
Statut:
ppublish
Résumé
Sugammadex is associated with fewer postoperative complications, but its impact on 30-day unplanned readmission is unclear. This was a single-centre retrospective observational study of patients after major abdominal surgery between 2010 and 2017, where rocuronium was the only neuromuscular blocker used. The primary endpoint was the difference in incidence of 30-day unplanned readmission between reversal with sugammadex or neostigmine. The secondary endpoints were the length of hospital stay after surgery and related hospital charges (total charges excluding those related to surgery and anaesthesia). Analysis included propensity score matching and generalised mixed-effects modelling. Mixed-effects logistic regression analysis of 1479 patients (sugammadex: 355; neostigmine: 1124) showed that the incidence of 30-day unplanned readmission was 34% lower (odds ratio [OR]: 0.66, 95% confidence interval [CI]: 0.46-0.96, P=0.031), the length of hospital stay was 20% shorter (exponential regression coefficient: 0.80, 95% CI: 0.77-0.83, P<0.001), and related hospital charges were 24% lower (exponential regression coefficient: 0.76, 95% CI: 0.67-0.87, P<0.001) in the sugammadex group than in the neostigmine group. For patients living ≥50 km from the hospital, the incidence of 30-day unplanned readmission was 68% lower in the sugammadex group than in the neostigmine group (OR: 0.32, 95% CI: 0.13-0.79, P=0.014), while it was not significant for patients living <50 km from the hospital (P=0.319). Compared with neostigmine, reversal of rocuronium with sugammadex after major abdominal surgery was associated with a lower incidence of 30-day unplanned readmission, a shorter hospital stay, and lower related hospital charges.
Sections du résumé
BACKGROUND
BACKGROUND
Sugammadex is associated with fewer postoperative complications, but its impact on 30-day unplanned readmission is unclear.
METHODS
METHODS
This was a single-centre retrospective observational study of patients after major abdominal surgery between 2010 and 2017, where rocuronium was the only neuromuscular blocker used. The primary endpoint was the difference in incidence of 30-day unplanned readmission between reversal with sugammadex or neostigmine. The secondary endpoints were the length of hospital stay after surgery and related hospital charges (total charges excluding those related to surgery and anaesthesia). Analysis included propensity score matching and generalised mixed-effects modelling.
RESULTS
RESULTS
Mixed-effects logistic regression analysis of 1479 patients (sugammadex: 355; neostigmine: 1124) showed that the incidence of 30-day unplanned readmission was 34% lower (odds ratio [OR]: 0.66, 95% confidence interval [CI]: 0.46-0.96, P=0.031), the length of hospital stay was 20% shorter (exponential regression coefficient: 0.80, 95% CI: 0.77-0.83, P<0.001), and related hospital charges were 24% lower (exponential regression coefficient: 0.76, 95% CI: 0.67-0.87, P<0.001) in the sugammadex group than in the neostigmine group. For patients living ≥50 km from the hospital, the incidence of 30-day unplanned readmission was 68% lower in the sugammadex group than in the neostigmine group (OR: 0.32, 95% CI: 0.13-0.79, P=0.014), while it was not significant for patients living <50 km from the hospital (P=0.319).
CONCLUSIONS
CONCLUSIONS
Compared with neostigmine, reversal of rocuronium with sugammadex after major abdominal surgery was associated with a lower incidence of 30-day unplanned readmission, a shorter hospital stay, and lower related hospital charges.
Identifiants
pubmed: 30770055
pii: S0007-0912(18)31370-9
doi: 10.1016/j.bja.2018.11.028
pii:
doi:
Substances chimiques
Cholinesterase Inhibitors
0
Sugammadex
361LPM2T56
Neostigmine
3982TWQ96G
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
370-378Commentaires et corrections
Type : CommentIn
Type : ErratumIn
Type : CommentIn
Informations de copyright
Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.