Association of sugammadex reversal of neuromuscular block and postoperative length of stay in the ambulatory care facility: a multicentre hospital registry study
Issued Date
2023-03-01
Resource Type
ISSN
00070912
eISSN
14716771
Scopus ID
2-s2.0-85144744915
Pubmed ID
36535827
Journal Title
British Journal of Anaesthesia
Volume
130
Issue
3
Start Page
296
End Page
304
Rights Holder(s)
SCOPUS
Bibliographic Citation
British Journal of Anaesthesia Vol.130 No.3 (2023) , 296-304
Suggested Citation
Azimaraghi O., Ahrens E., Wongtangman K., Witt A.S., Rupp S., Suleiman A., Tartler T.M., Wachtendorf L.J., Fassbender P., Choice C., Houle T.T., Eikermann M., Schaefer M.S. Association of sugammadex reversal of neuromuscular block and postoperative length of stay in the ambulatory care facility: a multicentre hospital registry study. British Journal of Anaesthesia Vol.130 No.3 (2023) , 296-304. 304. doi:10.1016/j.bja.2022.10.044 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/82386
Title
Association of sugammadex reversal of neuromuscular block and postoperative length of stay in the ambulatory care facility: a multicentre hospital registry study
Other Contributor(s)
Abstract
Background: Encapsulation of rocuronium or vecuronium with sugammadex can reverse neuromuscular block faster than neostigmine reversal. This pharmacodynamic profile might facilitate patient discharge after ambulatory surgery. Methods: We included patients who underwent ambulatory surgery with general anaesthesia and neuromuscular block between 2016 and 2021 from hospital registries at two large academic healthcare networks in the USA. The primary outcome was postoperative length of stay in the ambulatory care facility (PLOS-ACF). We examined post hoc whether the type of reversal affects postoperative nausea and vomiting and direct hospital costs. Results: Among the 29 316 patients included, 8945 (30.5%) received sugammadex and 20 371 (69.5%) received neostigmine for reversal. PLOS-ACF and costs were lower in patients who received sugammadex vs neostigmine (adjusted difference in PLOS-ACF: –9.5 min; 95% confidence interval [95% CI], –10.5 to –8.5 min; adjusted difference in direct hospital costs: –US$77; 95% CI, –$88 to –$66; respectively; P<0.001). The association was magnified in patients over age 65 yr, with ASA physical status >2 undergoing short procedures (<2 h) (adjusted difference in PLOS-ACF: –18.2 min; 95% CI, –23.8 to –12.4 min; adjusted difference in direct hospital costs: –$176; 95% CI, –$220 to –$128; P<0.001). Sugammadex use was associated with reduced postoperative nausea and vomiting (17.2% vs 19.6%, P<0.001), which mediated its effects on length of stay. Conclusions: Reversal with sugammadex compared with neostigmine was associated with a small decrease in postoperative length of stay in the ambulatory care unit. The effect was magnified in older and high-risk patients, and can be explained by reduced postoperative nausea and vomiting. Sugammadex reversal in ambulatory surgery may also help reduce cost of care.