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Background: Sugammadex is associated with fewer postoperative complications, but its impact on 30-day unplanned readmission is unclear. Methods: This was a single-centre retrospective observational study of patients after major abdominal surgery between 2010 and 2017, where rocuronium was the only neuromuscular blocker used. The primary endpoint was the difference in incidence of 30-day unplanned readmission between reversal with sugammadex or neostigmine. The secondary endpoints were the length of hospital stay after surgery and related hospital charges (total charges excluding those related to surgery and anaesthesia). Analysis included propensity score matching and generalised mixed-effects modelling. Results: Mixed-effects logistic regression analysis of 1479 patients (sugammadex: 355; neostigmine: 1124) showed that the incidence of 30-day unplanned readmission was 34% lower (odds ratio [OR]: 0.66, 95% confidence interval [CI]: 0.46e0.96, P¼0.031), the length of hospital stay was 20% shorter (exponential regression coefficient: 0.80, 95% CI: 0.77e0.83, P<0.001), and related hospital charges were 24% lower (exponential regression coefficient: 0.76, 95% CI: 0.67e0.87, P<0.001) in the sugammadex group than in the neostigmine group. For patients living !50 km from the hospital, the incidence of 30-day unplanned readmission was 68% lower in the sugammadex group than in the neostigmine group (OR: 0.32, 95% CI: 0.13e0.79, P¼0.014), while it was not significant for patients living <50 km from the hospital (P¼0.319). Conclusions: Compared with neostigmine, reversal of rocuronium with sugammadex after major abdominal surgery was associated with a lower incidence of 30-day unplanned readmission, a shorter hospital stay, and lower related hospital charges.

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The use of sugammadex can reduce post-operative residual neuromuscular blockade, which is known to increase the risk of post-operative respiratory events. However, its effect on post-operative pulmonary complications is not obvious. This study was performed to evaluate the effects of sugammadex on post-operative pulmonary complications in patients undergoing laparoscopic gastrectomy between 2013 and 2017. We performed propensity score matching to correct for selection bias. Post-operative pulmonary complications (i.e., pneumonia, respiratory failure, pleural effusion, atelectasis, pneumothorax, and aspiration pneumonitis) were evaluated from the radiological and laboratory findings. We also evaluated admission to the intensive care unit after surgery, re-admission or an emergency room visit within 30 days after discharge, length of hospital stay, re-operation, and mortality within 90 days post-operatively as secondary outcomes. In the initial cohort of 3802 patients, 541 patients were excluded, and 1232 patients were analyzed after propensity score matching. In the matched cohort, pleural effusion was significantly reduced in the sugammadex group compared to the neostigmine group (neostigmine 23.4% vs. sugammadex 18%, p = 0.02). Other pulmonary complications and secondary outcomes were not significantly different between the groups. In comparison to neostigmine, the use of sugammadex was associated with a lower incidence of post-operative pleural effusion in laparoscopic gastrectomy.

An augmented reality (AR) near-eye display using Pancharatnam-Berry (PB) phase lenses is proposed. PB phase lenses provide different optical effects depending on the polarization state of the incident light. By exploiting this characteristic, it is possible to manufacture an AR combiner with a small form factor and a large numerical aperture value. The AR combiner adopted in the proposed system operates as a convex lens for right-handed circularly polarized light and operates as transparent glass for left-handed circularly polarized light. By merging this combiner with a transparent screen, such as diffuser-holographic optical elements (DHOEs), it is possible to make an AR near-eye display with a small form factor and a wide field of view. In addition, the proposed AR system compensates the chromatic aberration that occurs in PB phase lens by adopting three-layered DHOEs. The operating principle of the proposed system is covered, and its feasibility is verified with experiments and analysis.

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