Association between choice of reversal agent for neuromuscular block and postoperative pulmonary complications in patients at increased risk undergoing non-emergency surgery: STIL-STRONGER, a multicentre matched cohort study Journal Article
| Authors: | Colquhoun, D. A.; Vaughn, M. T.; Bash, L. D.; Janda, A.; Shah, N.; Ghaferi, A.; Sjoding, M.; Mentz, G.; Kheterpal, S.; and Multicenter Perioperative Outcomes Group (MPOG) Perioperative Clinical Research Committee |
| Contributor: | McCormick, P. J. |
| Article Title: | Association between choice of reversal agent for neuromuscular block and postoperative pulmonary complications in patients at increased risk undergoing non-emergency surgery: STIL-STRONGER, a multicentre matched cohort study |
| Abstract: | 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. © 2022 British Journal of Anaesthesia |
| Keywords: | adult; controlled study; aged; middle aged; retrospective studies; major clinical study; case control study; clinical trial; outcome assessment; cohort studies; cohort analysis; kidney failure; retrospective study; high risk patient; age; risk assessment; pneumonia; postoperative complication; postoperative complications; body mass; multicenter study; signal peptide; intracellular signaling peptides and proteins; comorbidity; general anesthesia; abdominal surgery; myasthenia gravis; risk reduction; surgical anatomy; thorax surgery; sex; respiratory insufficiency; respiratory failure; elective surgery; surgical patient; secondary analysis; drug choice; vecuronium; lung complication; adverse event; neuromuscular blocking agent; neuromuscular blocking; neuromuscular blocking agents; procedures; endotracheal intubation; cholinesterase inhibitor; cholinesterase inhibitors; inhalation anesthetic agent; nitrous oxide; postoperative pulmonary complications; rocuronium; neuromuscular blockade; pyridostigmine; very elderly; humans; human; male; female; article; neostigmine; sugammadex; american society of anaesthesiologists score; neuromuscular blocking drug; reversal of neuromuscular block; stil protein, human |
| Journal Title: | British Journal of Anaesthesia |
| Volume: | 130 |
| Issue: | 1 |
| ISSN: | 0007-0912 |
| Publisher: | Oxford University Press |
| Date Published: | 2023-01-01 |
| Start Page: | e148 |
| End Page: | e159 |
| Language: | English |
| DOI: | 10.1016/j.bja.2022.04.023 |
| PUBMED: | 35691703 |
| PROVIDER: | scopus |
| PMCID: | PMC9875908 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 February 2023 -- Source: Scopus |
