Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Br J Anaesth. 2019 Mar;122(3):370-378. doi: 10.1016/j.bja.2018.11.028. Epub 2019 Jan 2.
Sugammadex is associated with fewer postoperative complications, but its impact on 30-day unplanned readmission is unclear.
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.
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]: 0.46-0.96, P=0.031), the length of hospital stay was 20% shorter (exponential regression coefficient: 0.80, 95% CI: 0.77-0.83, P<0.001), and related hospital charges were 24% lower (exponential regression coefficient: 0.76, 95% CI: 0.67-0.87, 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: 0.13-0.79, P=0.014), while it was not significant for patients living <50 km from the hospital (P=0.319).
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.
尽管 氨甲环酸与较少的术后并发症相关，但它对 30 天非计划性再入院的影响尚不清楚。
这是一项单中心回顾性观察性研究，纳入 2010 年至 2017 年间行大型腹部手术的患者，所有患者术中仅使用罗库溴铵作为神经肌肉阻滞剂。主要终点为使用舒更葡糖钠或新斯的明逆转后 30 天非计划性再入院的发生率差异。次要终点为术后住院时间和相关住院费用（总费用，不包括手术和麻醉相关费用）。分析包括倾向评分匹配和广义混合效应模型。
对 1479 例患者（舒更葡糖钠组 355 例，新斯的明组 1124 例）进行混合效应逻辑回归分析显示，30 天非计划性再入院的发生率降低 34%（比值比[OR]：0.66，95%置信区间[CI]：0.46-0.96，P=0.031），住院时间缩短 20%（指数回归系数：0.80，95%CI：0.77-0.83，P<0.001），相关住院费用降低 24%（指数回归系数：0.76，95%CI：0.67-0.87，P<0.001）。对于距离医院≥50km 的患者，舒更葡糖钠组 30 天非计划性再入院的发生率比新斯的明组降低 68%（OR：0.32，95%CI：0.13-0.79，P=0.014），而对于距离医院<50km 的患者，两组间无显著差异（P=0.319）。
与新斯的明相比，大型腹部手术后使用舒更葡糖钠逆转罗库溴铵可降低 30 天非计划性再入院的发生率，缩短住院时间，降低相关住院费用。
