Location
Central Division
Start Date
26-10-2023 10:20 AM
End Date
26-10-2023 10:25 AM
Description
Abstract:
Background
Residual neuromuscular blockade increases morbidity and mortality following surgery with general anesthesia and paralysis. Optimal antagonism of pharmacologic muscle relaxation is critical to avoiding residual weakness and subsequent pneumonia. The clinical question that guided the investigation of the evidence was, ‘Among healthy adults requiring neuromuscular blockade during general anesthesia for elective, noncardiac surgery, does the use of sugammadex compared to neostigmine for reversal of neuromuscular blockade influence the rate of postoperative pneumonia within seven days?’
Purpose
The primary purpose of this evidence-based practice project was to describe the rates of pneumonia among healthy adults antagonized with neostigmine or sugammadex at two hospitals in Eastern Washington.
Methods
The literature demonstrated that sugammadex compared to neostigmine was superior in the reduction of pneumonia in high-risk and older adults. This project targeted healthy adult patients undergoing general anesthesia with paralysis at PSHMC and PHFH. N = 10,395. The primary outcome was the rate of pneumonia diagnosed between anesthesia start to seven postoperative days or discharge among healthy adults that have received sugammadex or neostigmine for reversal of an aminosteroid nondepolarizing neuromuscular blocking agent following general anesthesia for elective, noncardiac surgery from March 1, 2017 to February 28, 2020. The secondary outcome was the differences in length of stay in those who developed pneumonia. Descriptive analysis was used to characterize the sample. Bivariate analysis identified independent risk factors for pneumonia. Logistic regression and multi-variable analysis were applied to examine the relationship between the identified covariates and the outcome.
Results
A low prevalence of pneumonia (0.12%) was discovered. This project did not find an association between the use of sugammadex or neostigmine and pneumonia in healthy adults (p = .10). Three independent risk factors were identified for postoperative diagnosis of pneumonia, including sex, smoking status, and intraoperative blood transfusions. The adjusted odds of developing pneumonia as a smoker (OR = 7.55, 95% CI [2.24-25.41], p = .001) and receiving a blood transfusion (OR = 7.59, 95% CI [0.93-61.94], p = .06) were increased, whereas the adjusted odds were decreased as a female (OR = 0.21, 95% CI [0.06-0.79], p = .02). Mean group differences were observed in length of stay between those that developed pneumonia, those who were reversed with sugammadex and did not develop pneumonia, and those who were reversed with neostigmine (p = .02).
Conclusion
The low prevalence of pneumonia is not unforeseen as postoperative pneumonia is an uncommon diagnosis in healthy adults. While the choice of reversal agent is not associated with the diagnosis of pneumonia, patient sex, smoking status, and the use of intraoperative blood transfusions does. Health care costs were exacerbated in those that developed pneumonia as they had a longer length of stay and were reversed with a more expensive drug.
Implications
Additional pneumonia prevention in these populations could improve patient safety and reduce health care costs. Anesthesia professionals need to be aware of the risk factors influencing pneumonia to reduce complications following elective surgery.
Recommended Citation
Gorthy, Kirstie; Hemingway, Braden; Colorafi, Karen; and Daratha, Kenn, "Rates of Postoperative Pneumonia in Healthy Adults Receiving Neostigmine versus Sugammadex: A Multi-Center Evidence-Based Practice Project" (2023). Central Division Nurse Clinical Inquiry Conference. 21.
https://digitalcommons.providence.org/central_nurs_conf/2023/agenda/21
Included in
Rates of Postoperative Pneumonia in Healthy Adults Receiving Neostigmine versus Sugammadex: A Multi-Center Evidence-Based Practice Project
Central Division
Abstract:
Background
Residual neuromuscular blockade increases morbidity and mortality following surgery with general anesthesia and paralysis. Optimal antagonism of pharmacologic muscle relaxation is critical to avoiding residual weakness and subsequent pneumonia. The clinical question that guided the investigation of the evidence was, ‘Among healthy adults requiring neuromuscular blockade during general anesthesia for elective, noncardiac surgery, does the use of sugammadex compared to neostigmine for reversal of neuromuscular blockade influence the rate of postoperative pneumonia within seven days?’
Purpose
The primary purpose of this evidence-based practice project was to describe the rates of pneumonia among healthy adults antagonized with neostigmine or sugammadex at two hospitals in Eastern Washington.
Methods
The literature demonstrated that sugammadex compared to neostigmine was superior in the reduction of pneumonia in high-risk and older adults. This project targeted healthy adult patients undergoing general anesthesia with paralysis at PSHMC and PHFH. N = 10,395. The primary outcome was the rate of pneumonia diagnosed between anesthesia start to seven postoperative days or discharge among healthy adults that have received sugammadex or neostigmine for reversal of an aminosteroid nondepolarizing neuromuscular blocking agent following general anesthesia for elective, noncardiac surgery from March 1, 2017 to February 28, 2020. The secondary outcome was the differences in length of stay in those who developed pneumonia. Descriptive analysis was used to characterize the sample. Bivariate analysis identified independent risk factors for pneumonia. Logistic regression and multi-variable analysis were applied to examine the relationship between the identified covariates and the outcome.
Results
A low prevalence of pneumonia (0.12%) was discovered. This project did not find an association between the use of sugammadex or neostigmine and pneumonia in healthy adults (p = .10). Three independent risk factors were identified for postoperative diagnosis of pneumonia, including sex, smoking status, and intraoperative blood transfusions. The adjusted odds of developing pneumonia as a smoker (OR = 7.55, 95% CI [2.24-25.41], p = .001) and receiving a blood transfusion (OR = 7.59, 95% CI [0.93-61.94], p = .06) were increased, whereas the adjusted odds were decreased as a female (OR = 0.21, 95% CI [0.06-0.79], p = .02). Mean group differences were observed in length of stay between those that developed pneumonia, those who were reversed with sugammadex and did not develop pneumonia, and those who were reversed with neostigmine (p = .02).
Conclusion
The low prevalence of pneumonia is not unforeseen as postoperative pneumonia is an uncommon diagnosis in healthy adults. While the choice of reversal agent is not associated with the diagnosis of pneumonia, patient sex, smoking status, and the use of intraoperative blood transfusions does. Health care costs were exacerbated in those that developed pneumonia as they had a longer length of stay and were reversed with a more expensive drug.
Implications
Additional pneumonia prevention in these populations could improve patient safety and reduce health care costs. Anesthesia professionals need to be aware of the risk factors influencing pneumonia to reduce complications following elective surgery.
