Incidence of complications in the post-anesthesia care unit and associated healthcare utilization in patients undergoing non-cardiac surgery requiring neuromuscular blockade 2005–2013: A single center study - 22/11/17
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.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Incidence of major (2.1%) and minor (35.1%) complications in the PACU are common in patients having surgery |
• | ICU admission rate was 1.3% without any complications, 3% with any minor, and 54% with any major complication |
• | In-hospital mortality was 0.2% without any complication, 0.4% with any minor, and 3% with any major complication |
• | Reversal of muscle relaxants significantly reduces risk of any major complication (1.7% vs. 6.0) |
Keywords : Neuromuscular blockade, Postoperative complications, PACU
Plan
| ☆ | Received from the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States. |
Vol 43
P. 33-38 - décembre 2017 Retour au numéro
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