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

Abstract

Background: Sugammadex is associated with fewer postoperative complications, but its impact on 30-day unplanned readmission is unclear. Methods: This was a single-centre retrospective observational study of patients after major abdominal surgery between 2010 and 2017, where rocuronium was the only neuromuscular blocker used. The primary endpoint was the difference in incidence of 30-day unplanned readmission between reversal with sugammadex or neostigmine. The secondary endpoints were the length of hospital stay after surgery and related hospital charges (total charges excluding those related to surgery and anaesthesia). Analysis included propensity score matching and generalised mixed-effects modelling. Results: Mixed-effects logistic regression analysis of 1479 patients (sugammadex: 355; neostigmine: 1124) showed that the incidence of 30-day unplanned readmission was 34% lower (odds ratio [OR]: 0.66, 95% confidence interval [CI]: 0.46e0.96, P¼0.031), the length of hospital stay was 20% shorter (exponential regression coefficient: 0.80, 95% CI: 0.77e0.83, P<0.001), and related hospital charges were 24% lower (exponential regression coefficient: 0.76, 95% CI: 0.67e0.87, P<0.001) in the sugammadex group than in the neostigmine group. For patients living !50 km from the hospital, the incidence of 30-day unplanned readmission was 68% lower in the sugammadex group than in the neostigmine group (OR: 0.32, 95% CI: 0.13e0.79, P¼0.014), while it was not significant for patients living <50 km from the hospital (P¼0.319). Conclusions: Compared with neostigmine, reversal of rocuronium with sugammadex after major abdominal surgery was associated with a lower incidence of 30-day unplanned readmission, a shorter hospital stay, and lower related hospital charges.

Effect of reversal of deep neuromuscular block with sugammadex or moderate block by neostigmine on shoulder pain in elderly patients undergoing robotic prostatectomy

“…9e12 Recent evidence suggests that the use of sugammadex may be associated with shorter hospital length of stay (LOS) and reduced hospital readmission after some major abdominal surgeries; however, additional research is needed to determine whether these findings are generalisable to other patient populations. 13 Elderly patients undergoing robotic prostatectomy may particularly benefit from reversal of neuromuscular block with sugammadex compared with neostigmine. 14 Compared with the general population, elderly patients have a higher incidence of postoperative pulmonary complications from residual neuromuscular block.…”

Does reversal of neuromuscular block with sugammadex reduce readmission rate after surgery?

“…18 These complications could in part explain why patients with residual neuromuscular block demonstrate an increase in ICU admission rate and prolonged hospital length of stay, 19 and increased rates of readmission among ambulatory patients. 7 The findings of Oh and colleagues 4 are interesting and thought provoking in this context.…”

“…1 There are several scenarios where readmissions might be missed. In the context of the study by Oh and colleagues, 4 uncaptured readmissions occur when complications associated with the use of neuromuscular reversal agents are treated in other hospitals far away from the study site. Mortality can also affect the rate of readmission, as patients who died would no longer be at risk for readmission.…”

“…Readers are further referred to Blobner and colleagues' 8 editorial on this topic which further discusses methodological considerations that should considered when evaluating associations such as that reported by Oh and colleagues. 4 Can neuromuscular blocking agents and neostigmine affect long-term outcomes?…”

Association of neuromuscular reversal by sugammadex and neostigmine with 90-day mortality after non-cardiac surgery

“…First, PORC and NMBA reversal with high-dose neostigmine is known to be associated with development of hypopharyngeal weakness [30,31], which could lead to a risk of aspiration and pneumonia, and overall higher rates of PPCs [26,32,33]. Furthermore, we recently published an observational study in which we showed that NMBA reversal by sugammadex was associated with lower 30-day unplanned readmission rates, hospital charges, and length of hospital stay after major abdominal surgery [34]. In this study, we showed that reversal by sugammadex, which might be closely related to reduced PORC, could have relatively long-term effects on outcome, beyond the immediate postoperative period.…”