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

Crispiana Cozowicz (First author), Haoyan Zhong, Jashvant Poeran, Alex Illescas, Jiabin Liu, Lazaros A Poultsides, Vassilis Athanassoglou, Stavros G Memtsoudis* (Last author)

*Corresponding author for this work

Research output: Contribution to journalOriginal Articlepeer-review

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).

CONCLUSIONS: 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.

Original languageEnglish
Pages (from-to)374-380
Number of pages7
JournalEUROPEAN JOURNAL OF ANAESTHESIOLOGY
Volume41
Issue number5
DOIs
Publication statusPublished - 1 May 2024

Keywords

  • Humans
  • Neostigmine/adverse effects
  • Sugammadex
  • Retrospective Studies
  • Neuromuscular Blockade/adverse effects
  • Orthopedic Procedures
  • Cholinesterase Inhibitors/adverse effects

Fingerprint

Dive into the research topics of 'Impact of sugammadex and neostigmine on outcome after major orthopaedic surgery: A population-based analysis'. Together they form a unique fingerprint.

Cite this