Sugammadex vs. neostigmine and the risk of postoperative pulmonary complications after upper gastrointestinal endoscopic procedures: a propensity score matched analysis of 15,730 patients
Yung‐Fong Tsai, Kuo‐Chuan Hung, Chih‐Yi Hsu, Huan‐Tang Lin, Yi‐Chen Lai, Shao‐Chun WuSummary
Introduction
Postoperative pulmonary complications after upper gastrointestinal endoscopic procedures under general anaesthesia are clinically important and may be exacerbated by residual neuromuscular block. We evaluated whether antagonism of neuromuscular block with sugammadex rather than neostigmine is associated with improved respiratory outcomes in this setting.
Methods
We performed a retrospective multicentre cohort study using a federated health record network. Adults undergoing upper gastrointestinal endoscopy who received rocuronium and antagonism of neuromuscular blockade with either sugammadex or neostigmine were identified. Propensity score matched analysis was conducted. The primary outcome was failure of tracheal extubation, defined as postoperative ventilator dependence or tracheal reintubation within 30 days. Secondary outcomes included coded lung atelectasis and unplanned admission to an ICU. A prespecified subgroup analysis was performed in patients without chronic pulmonary disease.
Results
After matching, 15,730 patients were included (7865 per group). Failure of tracheal extubation occurred in 305 patients (3.88%) in the sugammadex group and 455 patients (5.79%) in the neostigmine group (risk ratio 1.49, 95%CI 1.30–1.72, p < 0.0001), an absolute risk reduction of 1.91% and a number needed to treat of 52. Sugammadex was also associated with lower rates of lung atelectasis or collapse (6.74% compared with 7.76%, p = 0.014) and unplanned ICU admission (8.27% compared with 9.45%, p = 0.009). In the subgroup without chronic pulmonary disease (4624 patient pairs), failure of tracheal extubation occurred in 3.05% and 4.97% and unplanned ICU admission in 6.66% and 8.54% after sugammadex and neostigmine, respectively (all p < 0.001).
Discussion
In this large cohort of adults undergoing upper gastrointestinal endoscopy, sugammadex use was associated with important reductions in tracheal extubation failure, lung atelectasis or collapse, and unplanned ICU admission compared with neostigmine, including in those patients without known chronic pulmonary disease.