Impact of high- versus low-dose neuromuscular blocking agent administration on unplanned 30-day readmission rates in retroperitoneal laparoscopic surgery
Recent data shows that a neuromuscular block (NMB) induced by administration of high doses of rocuronium improves surgical conditions in certain procedures. However, there are limited data on the effect such practices on postoperative outcomes. We performed a retrospective analysis to compare unplan...
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| description | Recent data shows that a neuromuscular block (NMB) induced by administration of high doses of rocuronium improves surgical conditions in certain procedures. However, there are limited data on the effect such practices on postoperative outcomes. We performed a retrospective analysis to compare unplanned 30-day readmissions in patients that received high-dose versus low-dose rocuronium administration during general anesthesia for laparoscopic retroperitoneal surgery. This retrospective cohort study was performed in the Netherlands in an academic hospital where routine high-dose rocuronium NMB has been practiced since July 2015. Charts of patients receiving anesthesia between January 2014 and December 2016 were searched for surgical cases receiving high-dose rocuronium and matched with respect to procedure, age, sex and ASA classification to patients receiving low-dose rocuronium. The primary post-operative outcome was unplanned 30-day readmission rate. There were 130 patients in each cohort. Patients in the high- and low-dose rocuronium cohorts received 217 ± 49 versus 37 ± 5 mg rocuronium, respectively. In the high-dose rocuronium group neuromuscular activity was consistently monitored; matched patients were unreliably monitored. All patients receiving high-dose rocuronium were reversed with sugammadex, while just 33% of matched patients were reversed with sugammadex and 20% with neostigmine; the remaining patients were not reversed. Unplanned 30-day readmission rate was significantly lower in the high-dose compared to the low-dose rocuronium cohort (3.8% vs. 12.7%; p = 0.03; odds ratio = 0.33, 95% C.I. 0.12-0.95). This small retrospective study demonstrates a lower incidence of unplanned readmissions within 30-days following laparoscopic retroperitoneal surgery with high-dose relaxant anesthesia and sugammadex reversal in comparison to low-dose relaxant anesthesia. Further prospective studies are needed in larger samples to corroborate our findings and additionally assess the pharmacoeconomics of high-dose relaxant anesthesia taking into account the benefits (reduced readmissions) and harm (cost of relaxants and reversal agents) of such practice. |
| doi_str_mv | 10.1371/journal.pone.0197036 |
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However, there are limited data on the effect such practices on postoperative outcomes. We performed a retrospective analysis to compare unplanned 30-day readmissions in patients that received high-dose versus low-dose rocuronium administration during general anesthesia for laparoscopic retroperitoneal surgery. This retrospective cohort study was performed in the Netherlands in an academic hospital where routine high-dose rocuronium NMB has been practiced since July 2015. Charts of patients receiving anesthesia between January 2014 and December 2016 were searched for surgical cases receiving high-dose rocuronium and matched with respect to procedure, age, sex and ASA classification to patients receiving low-dose rocuronium. The primary post-operative outcome was unplanned 30-day readmission rate. There were 130 patients in each cohort. Patients in the high- and low-dose rocuronium cohorts received 217 ± 49 versus 37 ± 5 mg rocuronium, respectively. In the high-dose rocuronium group neuromuscular activity was consistently monitored; matched patients were unreliably monitored. All patients receiving high-dose rocuronium were reversed with sugammadex, while just 33% of matched patients were reversed with sugammadex and 20% with neostigmine; the remaining patients were not reversed. Unplanned 30-day readmission rate was significantly lower in the high-dose compared to the low-dose rocuronium cohort (3.8% vs. 12.7%; p = 0.03; odds ratio = 0.33, 95% C.I. 0.12-0.95). This small retrospective study demonstrates a lower incidence of unplanned readmissions within 30-days following laparoscopic retroperitoneal surgery with high-dose relaxant anesthesia and sugammadex reversal in comparison to low-dose relaxant anesthesia. Further prospective studies are needed in larger samples to corroborate our findings and additionally assess the pharmacoeconomics of high-dose relaxant anesthesia taking into account the benefits (reduced readmissions) and harm (cost of relaxants and reversal agents) of such practice.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0197036</identifier><identifier>PMID: 29791482</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Abdomen ; Analysis ; Anesthesia ; Anesthesiology ; Biology and Life Sciences ; Blocking ; Colorectal surgery ; Dosage ; Dosage and administration ; Dose-response relationship ; Economics ; Gastrointestinal surgery ; General anesthesia ; Laparoscopy ; Medicare ; Medicine and Health Sciences ; Methods ; Neostigmine ; Patient outcomes ; Patients ; Pharmacological research ; Pharmacology ; Prospective payment systems ; Rocuronium bromide ; Surgery ; Surgical outcomes ; Systematic review</subject><ispartof>PloS one, 2018-05, Vol.13 (5), p.e0197036-e0197036</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Boon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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However, there are limited data on the effect such practices on postoperative outcomes. We performed a retrospective analysis to compare unplanned 30-day readmissions in patients that received high-dose versus low-dose rocuronium administration during general anesthesia for laparoscopic retroperitoneal surgery. This retrospective cohort study was performed in the Netherlands in an academic hospital where routine high-dose rocuronium NMB has been practiced since July 2015. Charts of patients receiving anesthesia between January 2014 and December 2016 were searched for surgical cases receiving high-dose rocuronium and matched with respect to procedure, age, sex and ASA classification to patients receiving low-dose rocuronium. The primary post-operative outcome was unplanned 30-day readmission rate. There were 130 patients in each cohort. Patients in the high- and low-dose rocuronium cohorts received 217 ± 49 versus 37 ± 5 mg rocuronium, respectively. 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Further prospective studies are needed in larger samples to corroborate our findings and additionally assess the pharmacoeconomics of high-dose relaxant anesthesia taking into account the benefits (reduced readmissions) and harm (cost of relaxants and reversal agents) of such practice.</description><subject>Abdomen</subject><subject>Analysis</subject><subject>Anesthesia</subject><subject>Anesthesiology</subject><subject>Biology and Life Sciences</subject><subject>Blocking</subject><subject>Colorectal surgery</subject><subject>Dosage</subject><subject>Dosage and administration</subject><subject>Dose-response relationship</subject><subject>Economics</subject><subject>Gastrointestinal surgery</subject><subject>General anesthesia</subject><subject>Laparoscopy</subject><subject>Medicare</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Neostigmine</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Pharmacological 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Rob</au><au>Warlé, Michiel</au><au>Aarts, Leon</au><au>Niesters, Marieke</au><au>Dahan, Albert</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of high- versus low-dose neuromuscular blocking agent administration on unplanned 30-day readmission rates in retroperitoneal laparoscopic surgery</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-05-23</date><risdate>2018</risdate><volume>13</volume><issue>5</issue><spage>e0197036</spage><epage>e0197036</epage><pages>e0197036-e0197036</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Recent data shows that a neuromuscular block (NMB) induced by administration of high doses of rocuronium improves surgical conditions in certain procedures. However, there are limited data on the effect such practices on postoperative outcomes. We performed a retrospective analysis to compare unplanned 30-day readmissions in patients that received high-dose versus low-dose rocuronium administration during general anesthesia for laparoscopic retroperitoneal surgery. This retrospective cohort study was performed in the Netherlands in an academic hospital where routine high-dose rocuronium NMB has been practiced since July 2015. Charts of patients receiving anesthesia between January 2014 and December 2016 were searched for surgical cases receiving high-dose rocuronium and matched with respect to procedure, age, sex and ASA classification to patients receiving low-dose rocuronium. The primary post-operative outcome was unplanned 30-day readmission rate. There were 130 patients in each cohort. Patients in the high- and low-dose rocuronium cohorts received 217 ± 49 versus 37 ± 5 mg rocuronium, respectively. In the high-dose rocuronium group neuromuscular activity was consistently monitored; matched patients were unreliably monitored. All patients receiving high-dose rocuronium were reversed with sugammadex, while just 33% of matched patients were reversed with sugammadex and 20% with neostigmine; the remaining patients were not reversed. Unplanned 30-day readmission rate was significantly lower in the high-dose compared to the low-dose rocuronium cohort (3.8% vs. 12.7%; p = 0.03; odds ratio = 0.33, 95% C.I. 0.12-0.95). This small retrospective study demonstrates a lower incidence of unplanned readmissions within 30-days following laparoscopic retroperitoneal surgery with high-dose relaxant anesthesia and sugammadex reversal in comparison to low-dose relaxant anesthesia. Further prospective studies are needed in larger samples to corroborate our findings and additionally assess the pharmacoeconomics of high-dose relaxant anesthesia taking into account the benefits (reduced readmissions) and harm (cost of relaxants and reversal agents) of such practice.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>29791482</pmid><doi>10.1371/journal.pone.0197036</doi><tpages>e0197036</tpages><orcidid>https://orcid.org/0000-0003-3161-3945</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Open Access: DOAJ - Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; Open Access: PubMed Central; Free Full-Text Journals in Chemistry; EZB Electronic Journals Library |
| subjects | Abdomen Analysis Anesthesia Anesthesiology Biology and Life Sciences Blocking Colorectal surgery Dosage Dosage and administration Dose-response relationship Economics Gastrointestinal surgery General anesthesia Laparoscopy Medicare Medicine and Health Sciences Methods Neostigmine Patient outcomes Patients Pharmacological research Pharmacology Prospective payment systems Rocuronium bromide Surgery Surgical outcomes Systematic review |
| title | Impact of high- versus low-dose neuromuscular blocking agent administration on unplanned 30-day readmission rates in retroperitoneal laparoscopic surgery |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-12T00%3A28%3A39IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Impact%20of%20high-%20versus%20low-dose%20neuromuscular%20blocking%20agent%20administration%20on%20unplanned%2030-day%20readmission%20rates%20in%20retroperitoneal%20laparoscopic%20surgery&rft.jtitle=PloS%20one&rft.au=Boon,%20Martijn&rft.date=2018-05-23&rft.volume=13&rft.issue=5&rft.spage=e0197036&rft.epage=e0197036&rft.pages=e0197036-e0197036&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0197036&rft_dat=%3Cgale_plos_%3EA540019439%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2043147987&rft_id=info:pmid/29791482&rft_galeid=A540019439&rft_doaj_id=oai_doaj_org_article_57046e74999848caaee2942012f1e7a4&rfr_iscdi=true |