The Effects of Postoperative Residual Neuromuscular Blockade on Hospital Costs and Intensive Care Unit Admission: A Population-Based Cohort Study
| Autor: | Hao Deng, Bijan Teja, Barry J. Kelly, Stephanie D. Grabitz, Matthias Eikermann, Khushi Chhagani, Nishan Rajaratnam, Tharusan Thevathasan |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Critical Care Medizin Rate ratio Delayed Emergence from Anesthesia law.invention Pacu Patient Admission law Medicine Humans Postoperative Period Prospective Studies Prospective cohort study Aged Retrospective Studies Neuromuscular Blockade Vecuronium Bromide biology business.industry Incidence Retrospective cohort study Odds ratio Length of Stay Middle Aged biology.organism_classification Intensive care unit Intensive Care Units Anesthesiology and Pain Medicine Treatment Outcome Anesthesia Data Interpretation Statistical Cohort Atracurium Female Rocuronium business |
| Zdroj: | Anesthesia and analgesia. 128(6) |
| ISSN: | 1526-7598 |
| Popis: | Postoperative residual neuromuscular blockade continues to be a frequent occurrence with a reported incidence rate of up to 64%. However, the effect of postoperative residual neuromuscular blockade on health care utilization remains unclear. We conducted a retrospective cohort study to investigate the effects of postoperative residual neuromuscular blockade on hospital costs (primary outcome), intensive care unit admission rate, and hospital length of stay (secondary outcomes).We performed a prespecified secondary analysis of data obtained in 2233 adult patients undergoing surgery under general anesthesia. Postoperative residual neuromuscular blockade was defined as a train-of-four ratio0.9 in the postanesthesia care unit (PACU). Our confounder model adjusted for a variety of patient, surgical, and anesthesia-related factors. We fitted truncated negative binomial regression models for hospital cost and hospital length of stay analyses and a logistic regression model for our intensive care unit admission analysis.Overall, 457 (20.5%) patients in our cohort had residual neuromuscular blockade on admission to the PACU. Postoperative residual neuromuscular blockade was not independently associated with increased hospital costs (adjusted incidence rate ratio, 1.04, CI, 0.98-1.11; P = .22). There were significantly higher odds of intensive care unit admission in those with postoperative residual neuromuscular blockade compared to those without (adjusted odds ratio, 3.03, CI, 1.33-6.87; P.01). Further, we found a trend toward increased hospital length of stay in patients with postoperative residual neuromuscular blockade (adjusted incidence rate ratio, 1.09; P = .06). Sensitivity analysis using the same model in the day of surgery admissions and ambulatory surgery confirmed our findings.Postoperative residual neuromuscular blockade at PACU admission was not significantly associated with increased hospital costs, but was associated with higher rates of intensive care unit admission. These findings support the view that clinicians should continue to work to reduce the rate of postoperative residual neuromuscular blockade. |
| Databáze: | OpenAIRE |
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