Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Harvard Medical School, 300 1st avenue, Boston, MA 02129, USA.
Br J Anaesth. 2017 Oct 1;119(4):595-605. doi: 10.1093/bja/aex240.
We hypothesised that intraoperative non-depolarising neuromuscular blocking agent (NMBA) dose is associated with 30-day hospital readmission.
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.
Clinicians used cisatracurium (mean dose [SD] 0.19 mg kg-1 [0.12]), rocuronium (0.83 mg kg-1 [0.53]) and vecuronium (0.14 mg kg-1 [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], P=0.02), 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], P=0.048).
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.
我们假设术中非去极化神经肌肉阻滞剂（NMBA）剂量与 30 天住院再入院相关。
对在一家三级护理医院接受全身麻醉下腹部手术的 13122 名成年患者的数据进行多变量回归分析，以检查术中给予的 NMBA 剂量对 30 天再入院（主要终点）、住院时间和住院费用的影响。
临床医生使用顺式阿曲库铵（平均剂量[标准差]0.19mg/kg[0.12]）、罗库溴铵（0.83mg/kg[0.53]）和维库溴铵（0.14mg/kg[0.07]）。术中给予 NMBA 与 30 天住院再入院风险呈剂量依赖性相关（第 5 五分位与第 1 五分位相比，调整后的优势比 1.89[95%置信区间（CI）1.26-2.84]；趋势检验 P 值：<0.001），延长住院时间（调整后的发病率比[AIRR]1.20[95%CI 1.11-1.29]；趋势检验 P 值：<0.001）和增加住院费用（AIRR 1.18[95%CI 1.13-1.24]；趋势检验 P 值：<0.001）。入院类型（同日手术与住院手术）显著改变了风险（交互项：调整后的优势比 1.31[95%CI 1.05-1.63]，P=0.02），在接受高剂量 NMBA 与低剂量 NMBA 的门诊手术患者中，调整后的再入院率为 2.61[95%CI 1.11-6.17]，趋势检验 P 值：<0.001。术中总新斯的明剂量增加了 30 天再入院的风险（调整后的优势比 1.04[1.0-1.08]，P=0.048）。
在回顾性分析中，腹部手术期间给予大剂量 NMBA 与 30 天再入院风险增加相关，尤其是在接受门诊手术的患者中。
