TY - JOUR
T1 - Association between choice of reversal agent for neuromuscular block and postoperative pulmonary complications in patients at increased risk undergoing non-emergency surgery
T2 - STIL-STRONGER, a multicentre matched cohort study
AU - Multicenter Perioperative Outcomes Group (MPOG) Perioperative Clinical Research Committee
AU - Colquhoun, Douglas A.
AU - Vaughn, Michelle T.
AU - Bash, Lori D.
AU - Janda, Allison
AU - Shah, Nirav
AU - Ghaferi, Amir
AU - Sjoding, Michael
AU - Mentz, Graciela
AU - Kheterpal, Sachin
AU - Craft, Robert
AU - Domino, Karen B.
AU - Freundlich, Robert E.
AU - Mathis, Michael R.
AU - McCormick, Patrick J.
AU - Naik, Bhiken I.
AU - Ruiz, Joseph
AU - Schonberger, Robert B.
AU - Schroeder, Rebecca A.
AU - Stewart, Alvin F.
AU - Taicher, Brad M.
AU - Tingle, Sarah
AU - Togioka, Brandon Michael
AU - Urman, Richard
AU - Vachhani, Shital
N1 - Funding Information:
Partial funding by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., (Rahway, NJ, USA) to the University of Michigan. Research reported in this publication was supported by US National Institute of General Medical Sciences and National Heart, Lung, and Blood Institute of the National Institutes of Health (Bethesda, MD, USA) under award numbers T32GM103730 (AJ) and K08HL159327 (DAC). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Partial funding by a Mentored Research Training Grant from Foundation for Anesthesia Education and Research (FAER) to DAC. Partial funding by departmental and institutional resources at each contributing site.
Funding Information:
The authors gratefully acknowledge the work of Michelle Romanowski in contributing to the data extraction from the Multicenter Perioperative Outcomes Group database and David Clark and Rachel Hurwitz for administrative support in the development of the manuscript. The authors gratefully acknowledge the valuable contributions to protocol and final manuscript review by the Multicenter Perioperative Outcomes Group Perioperative Clinical Research Committee (non-Author Collaborator Group). Non-author collaborators, Robert Craft, University of Tennessee, Knoxville, TN, USA, Karen B. Domino, University of Washington, Seattle, WA, USA, Robert E. Freundlich, Vanderbilt University Medical Center, Nashville, TN, USA, Michael R. Mathis, University of Michigan, Ann Arbor, MI, USA, Patrick J. McCormick, Memorial Sloan Kettering Cancer Center, New York, NY, USA, Bhiken I. Naik, University of Virginia, Charlottesville, VA, USA, Joseph Ruiz, MD Anderson Cancer Center, Houston, TX, USA, Robert B. Schonberger, Yale School of Medicine, New Haven, CT, USA, Rebecca A. Schroeder, Duke University Medical Center, Durham, NC, USA, Alvin F. Stewart, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Brad M. Taicher, Duke University Medical Center, Durham, NC, USA, Sarah Tingle, MD, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Brandon Michael Togioka, Oregon Health & Science University, Portland, OR, USA, Richard Urman, Brigham and Women's Hospital, Boston, MA, USA, Shital Vachhani, MD Anderson Cancer Center, Houston, TX, USA
Publisher Copyright:
© 2022 British Journal of Anaesthesia
PY - 2023/1
Y1 - 2023/1
N2 - Background: Postoperative pulmonary complications are a source of morbidity after major surgery. In patients at increased risk of postoperative pulmonary complications we sought to assess the association between neuromuscular blocking agent reversal agent and development of postoperative pulmonary complications. Methods: We conducted a retrospective matched cohort study, a secondary analysis of data collected in the prior STRONGER study. Data were obtained from the Multicenter Perioperative Outcomes Group. Included patients were aged 18 yr and older undergoing non-emergency surgery under general anaesthesia with tracheal intubation with neuromuscular block and reversal, who were predicted to be at elevated risk of postoperative pulmonary complications. This risk was defined as American Society of Anesthesiologists Physical Status 3 or 4 in patients undergoing either intrathoracic or intra-abdominal surgery who were either aged >80 yr or underwent a procedure lasting >2 h. Cohorts were defined by reversal with neostigmine or sugammadex. The primary composite outcome was the occurrence of pneumonia or respiratory failure. Results: After matching by institution, sex, age (within 5 yr), body mass index, anatomic region of surgery, comorbidities, and neuromuscular blocking agent, 3817 matched pairs remained. The primary postoperative pulmonary complications outcome occurred in 224 neostigmine cases vs 100 sugammadex cases (5.9% vs 2.6%, odds ratio 0.41, P<0.01). After adjustment for unbalanced covariates, the adjusted odds ratio for the association between sugammadex use and the primary outcome was 0.39 (P<0.0001). Conclusions: In a cohort of patients at increased risk for pulmonary complications compared with neostigmine, use of sugammadex was independently associated with reduced risk of subsequent development of pneumonia or respiratory failure.
AB - Background: Postoperative pulmonary complications are a source of morbidity after major surgery. In patients at increased risk of postoperative pulmonary complications we sought to assess the association between neuromuscular blocking agent reversal agent and development of postoperative pulmonary complications. Methods: We conducted a retrospective matched cohort study, a secondary analysis of data collected in the prior STRONGER study. Data were obtained from the Multicenter Perioperative Outcomes Group. Included patients were aged 18 yr and older undergoing non-emergency surgery under general anaesthesia with tracheal intubation with neuromuscular block and reversal, who were predicted to be at elevated risk of postoperative pulmonary complications. This risk was defined as American Society of Anesthesiologists Physical Status 3 or 4 in patients undergoing either intrathoracic or intra-abdominal surgery who were either aged >80 yr or underwent a procedure lasting >2 h. Cohorts were defined by reversal with neostigmine or sugammadex. The primary composite outcome was the occurrence of pneumonia or respiratory failure. Results: After matching by institution, sex, age (within 5 yr), body mass index, anatomic region of surgery, comorbidities, and neuromuscular blocking agent, 3817 matched pairs remained. The primary postoperative pulmonary complications outcome occurred in 224 neostigmine cases vs 100 sugammadex cases (5.9% vs 2.6%, odds ratio 0.41, P<0.01). After adjustment for unbalanced covariates, the adjusted odds ratio for the association between sugammadex use and the primary outcome was 0.39 (P<0.0001). Conclusions: In a cohort of patients at increased risk for pulmonary complications compared with neostigmine, use of sugammadex was independently associated with reduced risk of subsequent development of pneumonia or respiratory failure.
KW - neostigmine
KW - neuromuscular blocking drug
KW - pneumonia
KW - postoperative pulmonary complications
KW - respiratory failure
KW - reversal of neuromuscular block
KW - sugammadex
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U2 - 10.1016/j.bja.2022.04.023
DO - 10.1016/j.bja.2022.04.023
M3 - Article
C2 - 35691703
AN - SCOPUS:85131842278
SN - 0007-0912
VL - 130
SP - e148-e159
JO - British journal of anaesthesia
JF - British journal of anaesthesia
IS - 1
ER -