Association of neuromuscular reversal by sugammadex and neostigmine with 90-day mortality after non-cardiac surgery.
Cholinesterase Inhibitors
/ pharmacology
Cohort Studies
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neostigmine
/ pharmacology
Neuromuscular Blockade
Neuromuscular Nondepolarizing Agents
/ antagonists & inhibitors
Postoperative Complications
/ mortality
Retrospective Studies
Rocuronium
/ antagonists & inhibitors
Sugammadex
/ pharmacology
Surgical Procedures, Operative
Time
Mortality
Muscle relaxation
Neostigmine
Sugammadex
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
20 02 2020
20 02 2020
Historique:
received:
02
11
2019
accepted:
17
02
2020
entrez:
22
2
2020
pubmed:
23
2
2020
medline:
26
1
2021
Statut:
epublish
Résumé
Reversing a neuromuscular blockade agent with sugammadex is known to lessen postoperative complications by reducing postoperative residual curarization. However, its effects on 90-day mortality are unknown. Therefore, this study aimed to compare the effects of sugammadex and neostigmine in terms of 90-day mortality after non-cardiac surgery. This retrospective cohort study analyzed the medical records of adult patients aged 18 years or older who underwent non-cardiac surgery at a single tertiary care hospital between 2011 and 2016. Propensity score matching and Cox regression analysis were used to investigate the effectiveness of sugammadex and neostigmine in lowering 90-day mortality after non-cardiac surgery. A total of 65,702 patients were included in the analysis (mean age: 52.3 years, standard deviation: 15.7), and 23,532 of these patients (35.8%) received general surgery. After propensity score matching, 14,179 patients (3906 patients from the sugammadex group and 10,273 patients from the neostigmine group) were included in the final analysis. Cox regression analysis in the propensity score-matched cohort showed that the risk of 90-day mortality was 40% lower in the sugammadex group than in the neostigmine group (hazard ratio: 0.60, 95% confidence interval: 0.37, 0.98; P = 0.042). These results were similar in the multivariable Cox regression analysis of the entire cohort (hazard ratio: 0.62, 95% confidence interval: 0.39, 0.96; P = 0.036). This retrospective cohort study suggested that reversing rocuronium with sugammadex might be associated with lower 90-day mortality after non-cardiac surgery compared to neostigmine. However, since this study did not evaluate quantitative neuromuscular function in the postoperative period due to its retrospective design, the results should be interpreted carefully. Future prospective studies with quantitative neuromuscular monitoring in the postoperative period should be performed to confirm these results.
Sections du résumé
BACKGROUND
Reversing a neuromuscular blockade agent with sugammadex is known to lessen postoperative complications by reducing postoperative residual curarization. However, its effects on 90-day mortality are unknown. Therefore, this study aimed to compare the effects of sugammadex and neostigmine in terms of 90-day mortality after non-cardiac surgery.
METHODS
This retrospective cohort study analyzed the medical records of adult patients aged 18 years or older who underwent non-cardiac surgery at a single tertiary care hospital between 2011 and 2016. Propensity score matching and Cox regression analysis were used to investigate the effectiveness of sugammadex and neostigmine in lowering 90-day mortality after non-cardiac surgery.
RESULTS
A total of 65,702 patients were included in the analysis (mean age: 52.3 years, standard deviation: 15.7), and 23,532 of these patients (35.8%) received general surgery. After propensity score matching, 14,179 patients (3906 patients from the sugammadex group and 10,273 patients from the neostigmine group) were included in the final analysis. Cox regression analysis in the propensity score-matched cohort showed that the risk of 90-day mortality was 40% lower in the sugammadex group than in the neostigmine group (hazard ratio: 0.60, 95% confidence interval: 0.37, 0.98; P = 0.042). These results were similar in the multivariable Cox regression analysis of the entire cohort (hazard ratio: 0.62, 95% confidence interval: 0.39, 0.96; P = 0.036).
CONCLUSIONS
This retrospective cohort study suggested that reversing rocuronium with sugammadex might be associated with lower 90-day mortality after non-cardiac surgery compared to neostigmine. However, since this study did not evaluate quantitative neuromuscular function in the postoperative period due to its retrospective design, the results should be interpreted carefully. Future prospective studies with quantitative neuromuscular monitoring in the postoperative period should be performed to confirm these results.
Identifiants
pubmed: 32079528
doi: 10.1186/s12871-020-00962-7
pii: 10.1186/s12871-020-00962-7
pmc: PMC7033926
doi:
Substances chimiques
Cholinesterase Inhibitors
0
Neuromuscular Nondepolarizing Agents
0
Sugammadex
361LPM2T56
Neostigmine
3982TWQ96G
Rocuronium
WRE554RFEZ
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
41Références
Anesth Analg. 2015 Aug;121(2):366-72
pubmed: 25902322
Anesthesiology. 2014 Nov;121(5):959-68
pubmed: 25225821
Anaesth Intensive Care. 2013 May;41(3):374-9
pubmed: 23659401
J Clin Anesth. 2019 Aug;55:33-41
pubmed: 30594097
Anaesthesia. 2007 Aug;62(8):806-9
pubmed: 17635429
Acta Anaesthesiol Scand. 1997 Oct;41(9):1095-1103
pubmed: 9366929
Anesthesiology. 2009 Jun;110(6):1253-60
pubmed: 19417617
BMJ. 2012 Oct 15;345:e6329
pubmed: 23077290
Anesth Analg. 2010 Jul;111(1):110-9
pubmed: 19910616
Br J Anaesth. 2016 Feb;116(2):233-40
pubmed: 26787792
Br J Anaesth. 2015 Nov;115(5):743-51
pubmed: 25935840
Br J Anaesth. 2019 Mar;122(3):370-378
pubmed: 30770055
Anesth Analg. 2004 Oct;99(4):1080-5, table of contents
pubmed: 15385354
Anesth Analg. 2020 Mar;130(3):685-695
pubmed: 30896593
Pharmacotherapy. 2007 Aug;27(8):1181-8
pubmed: 17655516
Anesth Analg. 2017 May;124(5):1476-1483
pubmed: 28244947
Anesth Analg. 2019 Jun;128(6):1129-1136
pubmed: 31094777
Br J Anaesth. 2019 Mar;122(3):294-298
pubmed: 30770044
Br J Anaesth. 2006 Jan;96(1):36-43
pubmed: 16357116
Ann Surg. 1954 Jul;140(1):2-35
pubmed: 13159140
Lancet. 2012 Sep 22;380(9847):1059-65
pubmed: 22998715
Anesthesiology. 2005 Feb;102(2):257-68; quiz 491-2
pubmed: 15681938
Anesthesiology. 2017 Jan;126(1):173-190
pubmed: 27820709
Br Med J. 1952 Oct 25;2(4790):891-2
pubmed: 12978375
Anaesthesia. 1969 Jul;24(3):395-416
pubmed: 4892960
Anesth Analg. 2008 Jul;107(1):130-7
pubmed: 18635478
Anaesthesia. 2015 Dec;70(12):1441-52
pubmed: 26558858
Anesth Analg. 2018 Jul;127(1):71-80
pubmed: 29200077
Br J Anaesth. 2017 Jun 1;118(6):834-842
pubmed: 28575335
BMC Anesthesiol. 2017 Aug 4;17(1):101
pubmed: 28778151
Eur J Anaesthesiol. 2011 Dec;28(12):842-8
pubmed: 21455074
Br J Anaesth. 2007 Mar;98(3):302-16
pubmed: 17307778
Anesthesiology. 2002 Jan;96(1):45-50
pubmed: 11753000
Anaesthesia. 2018 May;73(5):631-641
pubmed: 29280475
Biometrics. 1996 Mar;52(1):249-64
pubmed: 8934595
Lancet Respir Med. 2019 Feb;7(2):129-140
pubmed: 30224322
Anesthesiology. 2005 Oct;103(4):695-703
pubmed: 16192761
Anesthesiology. 2010 Dec;113(6):1280-8
pubmed: 20980910