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

J Clin Anesth. 2017 Dec:43:33-38. doi: 10.1016/j.jclinane.2017.09.005. Epub 2017 Sep 30.

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.

Keywords: Neuromuscular blockade; PACU; Postoperative complications.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Airway Extubation / statistics & numerical data
  • Anesthesia Recovery Period
  • Cholinesterase Inhibitors / therapeutic use
  • Elective Surgical Procedures / adverse effects*
  • Elective Surgical Procedures / methods
  • Elective Surgical Procedures / statistics & numerical data
  • Hospital Mortality
  • Hospitalization / statistics & numerical data
  • Humans
  • Incidence
  • Intensive Care Units / statistics & numerical data
  • Intubation, Intratracheal / statistics & numerical data
  • Neostigmine / therapeutic use
  • Neuromuscular Blockade / adverse effects*
  • Neuromuscular Blockade / methods
  • Neuromuscular Blocking Agents / adverse effects*
  • Neuromuscular Blocking Agents / antagonists & inhibitors
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Postoperative Complications / chemically induced
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / prevention & control
  • Retrospective Studies

Substances

  • Cholinesterase Inhibitors
  • Neuromuscular Blocking Agents
  • Neostigmine