• Crispiana Cozowicz, Haoyan Zhong, Jashvant Poeran, Alex Illescas, Jiabin Liu, Lazaros A Poultsides, Vassilis Athanassoglou, and Stavros G Memtsoudis.
• From the Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria (CC, SGM), Hospital for Special Surgery, Department of Anesthesiology, Critical Care & Pain Management, Weill Cornell Medical College, New York, USA (HZ, AI, JL, SGM), Department of Orthopaedic Surgery/Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, USA (JP), Department of Anesthesiology, Weill Cornell Medicine, New York City, New York, USA (JL, SGM), Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou (LAP), Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece (LAP) and Nuffield Department of Anaesthetics, Oxford University Hospitals, Oxford, United Kingdom (VA).
• Eur J Anaesthesiol. 2024 May 1; 41 (5): 374380374-380.

BackgroundResidual neuromuscular blockade after surgery remains a major concern given its association with pulmonary complications. However, current clinical practices with and the comparative impact on perioperative risk of various reversal agents remain understudied.ObjectiveWe investigated the use of sugammadex and neostigmine in the USA, and their impact on postoperative complications by examining national data.DesignThis population-based retrospective study used national Premier Healthcare claims data.Setting And ParticipantsPatients undergoing total hip/knee arthroplasty (THA, TKA), or lumbar spine fusion surgery between 2016 and 2019 in the United States who received neuromuscular blocking agents.InterventionThe effects of sugammadex and neostigmine for pharmacologically enhanced reversal were compared with each other and with controls who received no reversal agent.Main Outcomesincluded pulmonary complications, cardiac complications, and a need for postoperative ventilation. Mixed-effects regression models compared the outcomes between neostigmine, sugammadex, and controls. We report odds ratios (OR) and 95% confidence intervals (CI). Bonferroni-adjusted P values of 0.008 were used to indicate significance.ResultsAmong 361 553 patients, 74.5% received either sugammadex (20.7%) or neostigmine (53.8%). Sugammadex use increased from 4.4% in 2016 to 35.4% in 2019, whereas neostigmine use decreased from 64.5% in 2016 to 43.4% in 2019. Sugammadex versus neostigmine or controls was associated with significantly reduced odds for cardiac complications (OR 0.86, 95% CI, 0.80 to 0.92 and OR 0.83, 95% CI, 0.78 to 0.89, respectively). Both sugammadex and neostigmine versus controls were associated with reduced odds for pulmonary complications (OR 0.85, 95% CI, 0.77 to 0.94 and OR 0.91, CI 0.85 to 0.98, respectively). A similar pattern of sugammadex and neostigmine was observed for a reduction in severe pulmonary complications, including the requirement of invasive ventilation (OR 0.54, 95% CI, 0.45 to 0.64 and OR 0.53, 95% CI, 0.46 to 0.6, respectively).ConclusionsPopulation-based data indicate that sugammadex and neostigmine both appear highly effective in reducing the odds of severe life-threatening pulmonary complications. Sugammadex, especially, was associated with reduced odds of cardiac complications.Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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