Allan W Belcher1, Steve Leung2, Barak Cohen2, Dongsheng Yang3, Edward J Mascha3, Alparslan Turan4, Leif Saager5, Kurt Ruetzler6. 1. Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, United States. 2. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States. 3. Department of Quantitative Health Sciences, Cleveland Clinic, OH, United States. 4. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States. 5. Outcomes Research Consortium, Cleveland, OH, United States; University of Michigan, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States. 6. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States. Electronic address: kurt.ruetzler@reflex.at.
Abstract
STUDY OBJECTIVE: The use of neuromuscular blockade agents (NMBA), had been associated with significant residual post-operative paralysis and morbidity. There is a lack of clinical evidence on incidence of postoperative complications within the post-anesthesia care unit (PACU) in patients exposed to intraoperative NMBA's. This study aims to estimate the incidence of post-operative complications associated with use of NMBAs and assessing its association with healthcare resource utilization. DESIGN: Retrospective cohort. SETTING: Post-anesthesia care unit in tertiary care center. PATIENTS: Adults having non-cardiac surgery and receiving NMBAs between April-2005 and December-2013 MEASUREMENTS: We assessed: 1) incidences of major and minor PACU complications, 2) incidence of any postoperative complication in patients receiving a NMBA reversal (neostigmine) vs. without. 3) We secondarily assessed the relationship between PACU complications and use of healthcare resources. MAIN RESULTS: The incidence of any major complications was 2.1% and that of any minor complication was 35.2%. ICU admission rate was 1.3% in patients without any complications, versus 5.2% in patients with any minor and 30.6% in patients with any major complication. ICU length of stay was prolonged in patients with any major (52.1±203h), compared to patients with any minor (6.2±64h) and with no complications (1.7±28h). Patients who received a NMBA and neostigmine, compared to without neostigmine, had a lower incidence of any major complication (1.7% vs. 6.05%), rate of re-intubation (0.8% vs. 4.6%) and unplanned ICU admission (0.8% vs. 3.2%). CONCLUSIONS: This study documents that incidence of major PACU complications after non-cardiac surgery was 2.1%, with the most frequent complications being re-intubation and ICU admission. Patients receiving NMBA reversal were at a lower risk of re-intubation and unplanned ICU admission, justifying routine use of reversals. Complete NMBA reversals are crucial in reducing preventable patient harm and healthcare utilization.
STUDY OBJECTIVE: The use of neuromuscular blockade agents (NMBA), had been associated with significant residual post-operative paralysis and morbidity. There is a lack of clinical evidence on incidence of postoperative complications within the post-anesthesia care unit (PACU) in patients exposed to intraoperative NMBA's. This study aims to estimate the incidence of post-operative complications associated with use of NMBAs and assessing its association with healthcare resource utilization. DESIGN: Retrospective cohort. SETTING: Post-anesthesia care unit in tertiary care center. PATIENTS: Adults having non-cardiac surgery and receiving NMBAs between April-2005 and December-2013 MEASUREMENTS: We assessed: 1) incidences of major and minor PACU complications, 2) incidence of any postoperative complication in patients receiving a NMBA reversal (neostigmine) vs. without. 3) We secondarily assessed the relationship between PACU complications and use of healthcare resources. MAIN RESULTS: The incidence of any major complications was 2.1% and that of any minor complication was 35.2%. ICU admission rate was 1.3% in patients without any complications, versus 5.2% in patients with any minor and 30.6% in patients with any major complication. ICU length of stay was prolonged in patients with any major (52.1±203h), compared to patients with any minor (6.2±64h) and with no complications (1.7±28h). Patients who received a NMBA and neostigmine, compared to without neostigmine, had a lower incidence of any major complication (1.7% vs. 6.05%), rate of re-intubation (0.8% vs. 4.6%) and unplanned ICU admission (0.8% vs. 3.2%). CONCLUSIONS: This study documents that incidence of major PACU complications after non-cardiac surgery was 2.1%, with the most frequent complications being re-intubation and ICU admission. Patients receiving NMBA reversal were at a lower risk of re-intubation and unplanned ICU admission, justifying routine use of reversals. Complete NMBA reversals are crucial in reducing preventable patient harm and healthcare utilization.
Authors: Aage Ko Alstrup; Pia Mt Afzelius; Svend B Jensen; Páll S Leifsson; Karen M Wegener; Ole L Nielsen Journal: J Am Assoc Lab Anim Sci Date: 2019-12-17 Impact factor: 1.232
Authors: Ron Magor; Inbal Dabush-Elisha; Daniel Aviram; Dana Karol; Adi Syn-Hershko; Reut Schvartz; Barak Cohen; Idit Matot Journal: Perioper Med (Lond) Date: 2022-08-23
Authors: Thaddeus P Budelier; Christopher Ryan King; Shreya Goswami; Anchal Bansal; Stephen H Gregory; Troy S Wildes; Joanna Abraham; Sherry L McKinnon; Amy Cooper; Ivan Kangrga; Jackie L Martin; Melissa Milbrandt; Alex S Evers; Michael S Avidan Journal: F1000Res Date: 2020-10-20