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Impact of sugammadex and neostigmine on outcome after major orthopaedic surgery: A population-based analysis – Lumbar Fusion

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The study examined the use of sugammadex and neostigmine in the USA for reversing residual neuromuscular blockade after surgery and their impact on postoperative complications. The research, conducted using national Premier Healthcare claims data, focused on patients undergoing specific surgeries between 2016 and 2019. Results showed that both sugammadex and neostigmine were effective in reducing severe pulmonary complications, with sugammadex being particularly beneficial in reducing cardiac complications. The study highlights the importance of pharmacologically enhanced reversal agents in minimizing the risk of postoperative complications in patients receiving neuromuscular blocking agents

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

S: Population-based data indicate that sugammadex and neostigmine both appear highly effective in reducing the odds of severe life-threatening pulmonary complications. Sugammadex, especially, was associated with reduced odds of cardiac complications.

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Eur J Anaesthesiol. 2024 Mar 18. doi: 10.1097/EJA.0000000000001979. Online ahead of print.ABSTRACTBACKGROUND: Residual neuromuscular blockade after surgery remains a major concern given its association with pulmonary complications. However, current clinical practices with and the comparative impact on perioperative risk of various reversal agents remain understudied.OBJECTIVE: We investigated the use of sugammadex and neostigmine in the,

Eur J Anaesthesiol. 2024 Mar 18. doi: 10.1097/EJA.0000000000001979. Online ahead of print.

ABSTRACT

BACKGROUND: Residual neuromuscular blockade after surgery remains a major concern given its association with pulmonary complications. However, current clinical practices with and the comparative impact on perioperative risk of various reversal agents remain understudied.

OBJECTIVE: We investigated the use of sugammadex and neostigmine in the USA, and their impact on postoperative complications by examining national data.

DESIGN: This population-based retrospective study used national Premier Healthcare claims data.

SETTING AND PARTICIPANTS: Patients undergoing total hip/knee arthroplasty (THA, TKA), or lumbar spine fusion surgery between 2016 and 2019 in the United States who received neuromuscular blocking agents.

INTERVENTION: The effects of sugammadex and neostigmine for pharmacologically enhanced reversal were compared with each other and with controls who received no reversal agent.

MAIN OUTCOMES: included pulmonary complications, cardiac complications, and a need for postoperative ventilation. Mixed-effects regression models compared the outcomes between neostigmine, sugammadex, and controls. We report odds ratios (OR) and 95% confidence intervals (CI). Bonferroni-adjusted P values of 0.008 were used to indicate significance.

RESULTS: Among 361 553 patients, 74.5% received either sugammadex (20.7%) or neostigmine (53.8%). Sugammadex use increased from 4.4% in 2016 to 35.4% in 2019, whereas neostigmine use decreased from 64.5% in 2016 to 43.4% in 2019. Sugammadex versus neostigmine or controls was associated with significantly reduced odds for cardiac complications (OR 0.86, 95% CI, 0.80 to 0.92 and OR 0.83, 95% CI, 0.78 to 0.89, respectively). Both sugammadex and neostigmine versus controls were associated with reduced odds for pulmonary complications (OR 0.85, 95% CI, 0.77 to 0.94 and OR 0.91, CI 0.85 to 0.98, respectively). A similar pattern of sugammadex and neostigmine was observed for a reduction in severe pulmonary complications, including the requirement of invasive ventilation (OR 0.54, 95% CI, 0.45 to 0.64 and OR 0.53, 95% CI, 0.46 to 0.6, respectively).

S: Population-based data indicate that sugammadex and neostigmine both appear highly effective in reducing the odds of severe life-threatening pulmonary complications. Sugammadex, especially, was associated with reduced odds of cardiac complications.

PMID:38497249 | DOI:10.1097/EJA.0000000000001979

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Impact of sugammadex and neostigmine on outcome after major orthopaedic surgery: A population-based analysis

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Eur J Anaesthesiol. 2024 Mar 18. doi: 10.1097/EJA.0000000000001979. Online ahead of print.ABSTRACTBACKGROUND: Residual neuromuscular blockade after surgery remains a major concern given its association with pulmonary complications. However, current clinical practices with and the comparative impact on perioperative risk of various reversal agents remain understudied.OBJECTIVE: We investigated the use of sugammadex and neostigmine in the

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