Abstract：
OBJECTIVE: Residual neuromuscular blockade has been linked to pulmonary complications in the postoperative period. This study aimed to determine whether sugammadex was associated with a lower risk of postoperative pulmonary complications (PPCs) compared with neostigmine.
METHODS: This retrospective cohort study was conducted in a tertiary academic medical center. Patients ≥18 year of age undergoing noncardiac surgical procedures with general anesthesia and mechanical ventilation were enrolled between January 2019 and September 2021. We identified all patients receiving rocuronium and reversal with neostigmine or sugammadex via electronic medical record review. The primary endpoint was a composite of PPCs (including pneumonia, atelectasis, respiratory failure, pulmonary embolism, pleural effusion, or pneumothorax). The incidence of PPCs was compared using propensity score analysis.
RESULTS: A total of 1786 patients were included in this study. Among these patients, 976 (54.6%) received neostigmine, and 810 (45.4%) received sugammadex. In the whole sample, PPCs occurred in 81 (4.54%) subjects (7.04% sugammadex vs. 2.46% neostigmine). Baseline covariates were well balanced between groups after overlap weighting. Patients in the sugammadex group had similar risk (overlap weighting OR: 0.75; 95% CI: 0.40 to 1.41) compared to neostigmine. The sensitivity analysis showed consistent results. In subgroup analysis, the interaction P-value for the reversal agents stratified by surgery duration was 0.011.
CONCLUSIONS: There was no significant difference in the rate of PPCs when the neuromuscular blockade was reversed with sugammadex compared to neostigmine. Patients undergoing prolonged surgery may benefit from sugammadex, which needs to be further investigated.
METHODS: This retrospective cohort study was conducted in a tertiary academic medical center. Patients ≥18 year of age undergoing noncardiac surgical procedures with general anesthesia and mechanical ventilation were enrolled between January 2019 and September 2021. We identified all patients receiving rocuronium and reversal with neostigmine or sugammadex via electronic medical record review. The primary endpoint was a composite of PPCs (including pneumonia, atelectasis, respiratory failure, pulmonary embolism, pleural effusion, or pneumothorax). The incidence of PPCs was compared using propensity score analysis.
RESULTS: A total of 1786 patients were included in this study. Among these patients, 976 (54.6%) received neostigmine, and 810 (45.4%) received sugammadex. In the whole sample, PPCs occurred in 81 (4.54%) subjects (7.04% sugammadex vs. 2.46% neostigmine). Baseline covariates were well balanced between groups after overlap weighting. Patients in the sugammadex group had similar risk (overlap weighting OR: 0.75; 95% CI: 0.40 to 1.41) compared to neostigmine. The sensitivity analysis showed consistent results. In subgroup analysis, the interaction P-value for the reversal agents stratified by surgery duration was 0.011.
CONCLUSIONS: There was no significant difference in the rate of PPCs when the neuromuscular blockade was reversed with sugammadex compared to neostigmine. Patients undergoing prolonged surgery may benefit from sugammadex, which needs to be further investigated.
摘要：
目的：残余神经肌肉阻滞与术后肺部并发症有关。这项研究旨在确定sugammadex是否与新斯的明相比，术后肺部并发症（PPC）的风险较低。
方法：本回顾性队列研究在三级学术医疗中心进行。在2019年1月至2021年9月期间，纳入年龄≥18岁的患者接受全身麻醉和机械通气的非心脏手术。我们通过电子病历审查确定了所有接受罗库溴铵和新斯的明或Sugammadex逆转的患者。主要终点是PPC的复合物（包括肺炎，肺不张,呼吸衰竭,肺栓塞,胸腔积液,或气胸)。使用倾向评分分析比较PPC的发生率。
结果：本研究共纳入1786例患者。在这些患者中,976人（54.6%）接受了新斯的明，810人(45.4%)收到sugammadex。在整个样本中，PPC发生在81名（4.54％）受试者中（7.04％sugammadexvs.2.46%新斯的明）。重叠加权后，基线协变量在组间平衡良好。sugammadex组的患者与新斯的明相比具有相似的风险（重叠加权OR：0.75；95％CI：0.40至1.41）。敏感性分析结果一致。在亚组分析中，按手术时间分层的逆转剂的交互作用P值为0.011.
结论：与新斯的明相比，当神经肌肉阻滞逆转时，PPC的比率没有显着差异。接受长时间手术的患者可能会受益于sugammadex，这需要进一步调查。
方法：本回顾性队列研究在三级学术医疗中心进行。在2019年1月至2021年9月期间，纳入年龄≥18岁的患者接受全身麻醉和机械通气的非心脏手术。我们通过电子病历审查确定了所有接受罗库溴铵和新斯的明或Sugammadex逆转的患者。主要终点是PPC的复合物（包括肺炎，肺不张,呼吸衰竭,肺栓塞,胸腔积液,或气胸)。使用倾向评分分析比较PPC的发生率。
结果：本研究共纳入1786例患者。在这些患者中,976人（54.6%）接受了新斯的明，810人(45.4%)收到sugammadex。在整个样本中，PPC发生在81名（4.54％）受试者中（7.04％sugammadexvs.2.46%新斯的明）。重叠加权后，基线协变量在组间平衡良好。sugammadex组的患者与新斯的明相比具有相似的风险（重叠加权OR：0.75；95％CI：0.40至1.41）。敏感性分析结果一致。在亚组分析中，按手术时间分层的逆转剂的交互作用P值为0.011.
结论：与新斯的明相比，当神经肌肉阻滞逆转时，PPC的比率没有显着差异。接受长时间手术的患者可能会受益于sugammadex，这需要进一步调查。
