Effect of patient decision aids on choice between sugammadex and neostigmine in surgeries under general anesthesia: a multicenter randomized controlled trial

Wang, Li‐Kai; Lin, Yuan‐Yung; Chen, Jui-Tai; Lan, Winnie; Hung, Kuo‐Chuan; Chen, Jen-Yin; Liu, Kuei-Jung; Yen, Yu-Chun; Chou, Yun-Yun; Cherng, Yih-Giun; Tam, Ka‐Wai

doi:10.4097/kja.22624

Cited by 2 publications

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“…This study was a retrospective sequential analysis of a published randomized controlled trial registered on Clinicaltrials.gov (identifier: NCT04272177) [24]. The two-center randomized controlled trial estimated the potential effect of patient decision aids (PtDA) on the choice of neuromuscular blocking reversal agents.…”

Section: Data Sourcementioning

confidence: 99%

Cost-Effectiveness of Sugammadex Versus Neostigmine to Reverse Neuromuscular Blockade in a University Hospital in Taiwan: A Propensity Score-Matched Analysis

et al. 2023

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Sugammadex has several pharmacological advantages over neostigmine, including faster reversal of neuromuscular blockade and fewer adverse effects. However, the economic impact of sugammadex remains controversial due to the considerable heterogeneity of study designs and clinical settings in previous studies. In a post-hoc analysis of a randomized controlled trial, we evaluated patients who underwent elective surgeries and general anesthesia with endotracheal intubation in a medical center in Taiwan between March 2020 and August 2020. Patients were divided into either the sugammadex or neostigmine group based on the neuromuscular blocking drug used. Propensity score matching was used to balance the baseline patient characteristics between the two groups. The patient’s recovery from anesthesia and the putative cost-effectiveness of sugammadex versus neostigmine was assessed. Derived cost-effectiveness using personnel costs in the operating room and the post-anesthesia care unit was estimated using multiple linear regression models. A total of 2587 and 1784 patients were included before and after matching, respectively. Time to endotracheal extubation was significantly shorter in the sugammadex group (mean 6.0 ± standard deviation 5.3 min) compared with the neostigmine group (6.6 ± 6.3 min; p = 0.0032). In addition, the incidence of bradycardia was significantly lower in the sugammadex group (10.2%) compared with the neostigmine group (16.9%; p < 0.001). However, the total costs were significantly lower in the neostigmine group (50.6 ± 21.4 United States dollars) compared with the sugammadex group (212.0 ± 49.5 United States dollars). Despite improving postoperative recovery, the benefits of sugammadex did not outweigh its higher costs compared with neostigmine, possibly due to the low costs of labor in Taiwan’s healthcare system.

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Section: Data Sourcementioning

confidence: 99%

Cost-Effectiveness of Sugammadex Versus Neostigmine to Reverse Neuromuscular Blockade in a University Hospital in Taiwan: A Propensity Score-Matched Analysis

et al. 2023

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“…These decision aids have been shown to increase discussion, enhance participation, and improve patients' knowledge of medical options in the decision-making processes, without increasing anxiety [5]. Wang et al [4] presented another example of this tool, which could promote shared decision making, in the current issue of the KJA.…”

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confidence: 99%

From evidence-based medicine to patient-centered care

Kim¹

2023

Korean J Anesthesiol

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In healthcare, interest in both evidence-based medicine (EBM) and patient-centered care (PCC) has grown over the past decade. While one could anticipate that a combination of EBM and PCC would enhance patient care, these two concepts also represent conflicting tendencies: standardization based on scientific knowledge and customization of medical practice based on patient and family preferences. To properly utilize EBM to deliver effective patient care, the Institute of Medicine has provided an updated definition of EBM that incorporates elements of PCC in clinical decision making; EBM provides specific tools for delivering high-quality care, and patients are involved in decision-making about the application of those tools [1,2]. Ideal healthcare decision making therefore requires that patients receive proper education using evidence-based data. To meet this end, patient decision aids have been utilized in various fields of medicine, including cardiology, urology, gynecology, endocrinology, oncology, and anesthesiology [3].The current issue of the Korean Journal of Anesthesiology (KJA) includes a randomized controlled trial conducted by Wang et al. [4] that evaluates whether providing patient decision aids on two neuromuscular blocking agent reversal options (neostigmine and sugammadex) to patients undergoing surgery under general anesthesia increases patient satisfaction with the decision-making process. A total of 3,132 surgical patients were recruited for this study from two medical centers, 2,986 of which completed the survey and were allocated to either the classical group, which received a standard explanation, or the PtDA group, which received a set of patient decision aids developed and tested by anesthesiologists from the two hospitals. The patients' degree of satisfaction with the decision-making process was evaluated using blinded outcome assessors, which included the four SURE (sure of myself, understand information, risk-benefit ratio, encouragement) screening test items. The patients' baseline information and medical knowledge were also assessed. Compared to the classical group, the PtDA group felt more confident they had received sufficient medical information (P < 0.001), felt better informed about the advantages and disadvantages of the medications (P < 0.001), exhibited a superior understanding of the benefits and risks of their options (P < 0.001), and felt more confident about their choice (P < 0.001). These observations suggest that patient decision aids can be used to improve the quality of communication between physicians and patients and promote shared decision making.As anesthesiologists generally perform the pre-anesthesia evaluation and consultation immediately before surgery, time is often limited and no established relationship with the patients and their families exists. Consequently, it may be difficult to provide anesthesia-related information adequately for patients to participate in the decision-making process without experiencing undue anxiety. Patient decision aids may thus be ...

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Effect of patient decision aids on choice between sugammadex and neostigmine in surgeries under general anesthesia: a multicenter randomized controlled trial

Abstract: This article has been accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination, and proofreading processes, which may lead to differences between this version and the version of record.

Cited by 2 publications

References 21 publications

Cost-Effectiveness of Sugammadex Versus Neostigmine to Reverse Neuromuscular Blockade in a University Hospital in Taiwan: A Propensity Score-Matched Analysis

Cost-Effectiveness of Sugammadex Versus Neostigmine to Reverse Neuromuscular Blockade in a University Hospital in Taiwan: A Propensity Score-Matched Analysis

From evidence-based medicine to patient-centered care

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