Postoperative Risk of Transfusion After Reversal of Residual Neuromuscular Block With Sugammadex Versus Neostigmine: A Retrospective Cohort Study

Abstract

BACKGROUND: Sugammadex and neostigmine are routinely used to reverse residual neuromuscular blocks at the end of surgery. Sugammadex has been linked with prolongation of laboratory coagulation markers, but clinical relevance on postoperative blood loss and transfusions remains unclear. METHODS: In this retrospective, single-center, cohort study, we analyzed medical records of adult patients having noncardiac surgery who were given sugammadex or neostigmine from May 2016 to December 2020. Our primary outcome was the incidence of any postoperative transfusion of red blood cells, and/or fresh-frozen plasma, and/or platelets. Secondary outcomes were duration of hospitalization, need for resurgery, and postoperative intensive care unit (ICU) admission. After propensity score weighting, the odds ratio (OR) for postoperative transfusion was assessed in both groups (sugammadex versus neostigmine) using a generalized estimation equation to count within-subject correlation weighted by the inverse propensity score. RESULTS: Out of 39,325 eligible surgeries, 33,903 surgeries in 29,062 patients were included in the analysis; with 4581 patients receiving sugammadex and 29,322 patients receiving neostigmine. The raw incidence of postoperative transfusion was 7.40% in sugammadex and 7.45% in the neostigmine group. After weighting by propensity score, the incidence of postoperative transfusion was 8.01% in the sugammadex and 7.38% in the neostigmine group (OR, 1.11 [95% confidence interval [CI], 0.97-1.26; P = .118]). There was no difference in duration of hospitalization and need for resurgery, but odds of postoperative ICU admission were significantly higher for patients receiving sugammadex than those receiving neostigmine (OR, 1.33 [98.33% CI, 1.17-1.52; P < .0001]). Our a priori planned analysis of coagulation laboratory parameters could not be completed because of a high amount of missing laboratory data. CONCLUSIONS: There is no statistically significant nor clinically important difference in the risk of postoperative transfusion in patients receiving sugammadex or neostigmine. (Anesth Analg 2023;136:745-52) KEY POINTSSummary statistics (presented as % of patients, mean ± SD, or median [Q1-Q3], respectively, for factors, symmetric continuous variables, and skewed continuous variables; Duration of surgery was summarized by median [10th, 90th percentiles]). Abbreviations: ASA, American Society of Anesthesiologists; ASD, absolute standardized difference; BMI, body mass index; IPTW, inverse probability of treatment weighting. a ASD is the absolute difference in means or proportions divided by the pooled standard deviation before or after weighting each observation with IPTW. Any covariate with an ASD >0.10 was considered to be imbalanced and would be adjusted for in the analysis.

Impact of Prone Jackknife Position on Intraoperative Hypotension During Percutaneous Nephroscopy: A Retrospective Matched Analysis

“…In case of existing differences, a 1:1 matching algorithm with a caliper size of 0.05 was applied to create matched pairs based on propensity scores. 15 , 16 Subsequently, another test was conducted to assess any remaining differences between the groups. Propensity matching categorized data into unmatched (original) and matched (balanced concerning risk factors other than body position), which can be beneficial in clarifying causal relationships.…”