Comparison of the effects of sugammadex versus neostigmine for reversal of neuromuscular block on hospital costs of care

Cost-Effectiveness of Sugammadex Versus Neostigmine to Reverse Neuromuscular Blockade in a University Hospital in Taiwan: A Propensity Score-Matched Analysis

“…Previous studies have shown that the cost-effectiveness of sugammadex compared with neostigmine can only be established when two premises are met [6,[17][18][19][20][21][22][23]. First, a reduction in recovery time could be achieved by using sugammadex as a routine reversal agent.…”

“…The clinical benefits of sugammadex versus neostigmine have been evaluated across a range of features, including rates of postoperative pulmonary complications, residual paralysis, postoperative nausea and vomiting (PONV), 30-day readmission, and cognitive function [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. A series of cost-effectiveness analyses in various healthcare settings were also performed to determine whether it was more economical for patients and healthcare systems to use sugammadex in routine clinical practice or for certain patient populations [6,[17][18][19][20][21][22][23]. However, due to the methodological diversity of study designs and variations in healthcare systems, studies have delivered conflicting outcomes, and the use of sugammadex is now somewhat controversial.…”

“…Hence, the economic benefits of sugammadex have not been fully evaluated due to some limitations in previous studies, including small sample size (n < 1000) [6,[17][18][19][20] and restriction to specific types of surgery [17,21]. In addition, most previous studies analyzed the cost-effectiveness of sugammadex in the hospitals of western countries (two in Italy [6,17] and three in the United States [20,22,23]). The economic impact of sugammadex remains unclear in Asian healthcare systems due to limited published data [21].…”

“…We reasoned that the use of sugammadex could accelerate the patient's emergence from general anesthesia, increasing operating turnover rates and, therefore, reducing total medical costs compared to neostigmine. Based on current evidence [6,[17][18][19][20][21][22][23], we hypothesized that the administration of sugammadex was associated with a shorter time to recovery and lower total costs related to surgical patients undergoing general anesthesia.…”

High Mechanical Power and Driving Pressures are Associated With Postoperative Respiratory Failure Independent From Patients’ Respiratory System Mechanics*

“…These included patient demographics and comorbidities such as age, sex, BMI (22), ASA physical status classification, the Charlson Comorbidity Index, the Score for Prediction of Postoperative Respiratory Complications (23), and smoking status (24). Furthermore, the model was adjusted for procedural duration, surgical service, work relative value units (based on Current Procedural Terminology [CPT] codes) as a surrogate for surgical complexity, total vasopressor dose, the total amount of administered crystalloid and colloid fluids (25), total nondepolarizing neuromuscular blocking agent dose (expressed as the median effective dose required to achieve a 95% reduction in maximal twitch response from baseline) (26)(27)(28), dose of long-and short-acting intraoperative opioids, neostigmine dose (26), number of packed RBC units administered (29), age-adjusted minimal alveolar concentration of inhalational anesthetics and nitrous oxide, airway device, use of sugammadex (19,30,31), use of succinylcholine, and Fio 2 . Lastly, we adjusted for the year in which the procedure was performed to account for potential trends over time.…”