Association between intraoperative non-depolarising neuromuscular blocking agent dose and 30-day readmission after abdominal surgery

Abstract

Background. We hypothesised that intraoperative non-depolarising neuromuscular blocking agent (NMBA) dose is associated with 30-day hospital readmission. Methods. Data from 13,122 adult patients who underwent abdominal surgery under general anaesthesia at a tertiary care hospital were analysed by multivariable regression, to examine the effects of intraoperatively administered NMBA dose on 30-day readmission (primary endpoint), hospital length of stay, and hospital costs. Results. Clinicians used cisatracurium (mean dose [SD] 0.19 mg kg À1 [0.12]), rocuronium (0.83 mg kg À1 [0.53]) and vecuronium (0.14 mg kg À1 [0.07]). Intraoperative administration of NMBAs was dose-dependently associated with higher risk of 30-day hospital readmission (adjusted odds ratio 1.89 [95% Confidence Interval (CI) 1.26-2.84] for 5th quintile vs 1st quintile; P for trend: P<0.001), prolonged hospital length of stay (adjusted incidence rate ratio [aIRR] 1.20 [95% CI 1.11-1.29]; P for trend: P<0.001) and increased hospital costs (aIRR 1.18 [95% CI 1.13-1.24]; P for trend: P<0.001). Admission type (same-day vs inpatient surgery) significantly modified the risk (interaction term: aOR 1.31 [95% CI 1.05-1.63], P¼0.02), and the adjusted odds of readmission in patients undergoing ambulatory surgical procedures who received high-dose NMBAs vs low-dose NMBAs amounted to 2.61 [95% CI 1.11-6.17], P for trend: P<0.001. Total intraoperative neostigmine dose increased the risk of 30-day readmission (aOR 1.04 [1.0-1.08], P¼0.048). Conclusions. In a retrospective analysis, high doses of NMBAs given during abdominal surgery was associated with an increased risk of 30-day readmission, particularly in patients undergoing ambulatory surgery.

Retrospective analysis of 30-day unplanned readmission after major abdominal surgery with reversal by sugammadex or neostigmine

“…There have been a few previous retrospective reports regarding 30-day readmission rate in relation to anaesthesia. 18,19 Thevathasan and colleagues 18 reported a positive association between intraoperative non-depolarising neuromuscular blocking agent dose and 30-day readmission after abdominal surgery. The likely reason for this difference from our results is that sugammadex administration was the main variable used in our mixed-effects logistic regression model, which might have nullified the effect of the rocuronium dose on 30-day unplanned readmission rate.…”

Association between intraoperative opioid administration and 30-day readmission: a pre-specified analysis of registry data from a healthcare network in New England

“…A sub-cohort of 13 122 patients (8.5%) of the included cohort was previously analysed in a published study examining the effects of neuromuscular blocking agents on 30-day readmission after abdominal surgery. 18…”

“…The exposure variable was the total dose of opioid administered intraoperatively, defined as quintiles of i.v. morphine equivalents adjusted for lean body weight, according to the following method: the total dose of each opioid medication in milligrams was multiplied by its standard equianalgesic conversion ratio, 18,19 and then divided by lean body weight. 20,21 No adjustment for incomplete cross tolerance was performed given the short duration of intraoperative exposure.…”

“…4B) were relatively small compared with the variation observed between anaesthesia providers. 24 1. were calculated using standard equianalgesic conversion ratios 18,19 with adjustment for lean body weight 21 and are reported in quintiles of i.v. morphine milligram equivalents.…”

“…Short-acting and long-acting equivalents were analysed separately using the logistic-regression model described in Supplementary eTable 1, which included adjustment for remifentanil exposure. Total short-acting and long-acting doses were calculated using standard equianalgesic conversion ratios 18,19 with adjustment for lean body weight, 21 and are reported in quintiles of fentanyl and hydromorphone equivalents, respectively. IQR, inter-quartile range; OR, odds ratio.…”