Evidence map›Paper›PMID 35691703›Full record

ArticleBritish journal of anaesthesia2023

Association between choice of reversal agent for neuromuscular block and postoperative pulmonary complications in patients at increased risk undergoing non-emergency surgery: STIL-STRONGER, a multicentre matched cohort study.

Douglas A Colquhoun, Michelle T Vaughn, Lori D Bash, Allison Janda, Nirav Shah, Amir Ghaferi, Michael Sjoding, Graciela Mentz, Sachin Kheterpal, Multicenter Perioperative Outcomes Group (MPOG) Perioperative Clinical Research Committee

Open access · greenAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in British journal of anaesthesia, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 2 pooled it
4.9field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 35 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 13 institutions in 1 country.

Douglas A ColquhounDepartment of Anesthesiology, University of Michigan, Ann Arbor, MI, USA. Electronic address: dougcolq@med.umich.edu.
Michelle T VaughnDepartment of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
Lori D BashMerck & Co., Inc., Rahway, NJ, USA.
Allison JandaDepartment of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
Nirav ShahDepartment of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
Amir GhaferiDepartment of Surgery, University of Michigan, Ann Arbor, MI, USA.
Michael SjodingDepartment of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Graciela MentzDepartment of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
Sachin KheterpalDepartment of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
Multicenter Perioperative Outcomes Group (MPOG) Perioperative Clinical Research Committee
University of Michigan · USDuke Medical Center · USThe University of Texas MD Anderson Cancer Center · USUniversity of Arkansas for Medical Sciences · USBrigham and Women's Hospital · USMemorial Sloan Kettering Cancer Center · USMerck & Co., Inc., Rahway, NJ, USA (United States) · USOregon Health & Science University · USUniversity of Tennessee at Knoxville · USUniversity of Virginia · USUniversity of Washington · USVanderbilt University Medical Center · USYale University · US

Funding

X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI Hongbiao Carl Lekaye · 1985 to 2026
$347.4M
Optimizing Clinician and AI Collaborations to Support Timely Management of Acute DyspneaR01HL158626 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Michael William Sjoding, Jenna Wiens · 2021 to 2026
$3.8M
University of Michigan Anesthesiology Post-Doctoral Research Training ProgramT32GM103730 · NIGMS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Chad M Brummett, SACHIN KHETERPAL · 2014 to 2026
$1.9M
Data-Driven Identification of the Acute Respiratory Distress SyndromeK01HL136687 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI SJODING, MICHAEL WILLIAM · 2017 to 2021
$862k
Data Driven Approaches to Improving Risk Prediction of Pulmonary Complications After Major Inpatient SurgeryK08HL159327 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI COLQUHOUN, DOUGLAS ALASTAIR · 2021 to 2025
$811k
NCI NIH HHS P30 CA008748NHLBI NIH HHS K01 HL136687NHLBI NIH HHS K08 HL159327NHLBI NIH HHS R01 HL158626NIGMS NIH HHS T32 GM103730
6 · The paper itself

Abstract

backgroundPostoperative pulmonary complications are a source of morbidity after major surgery. In patients at increased risk of postoperative pulmonary complications we sought to assess the association between neuromuscular blocking agent reversal agent and development of postoperative pulmonary complications.

methodsWe conducted a retrospective matched cohort study, a secondary analysis of data collected in the prior STRONGER study. Data were obtained from the Multicenter Perioperative Outcomes Group. Included patients were aged 18 yr and older undergoing non-emergency surgery under general anaesthesia with tracheal intubation with neuromuscular block and reversal, who were predicted to be at elevated risk of postoperative pulmonary complications. This risk was defined as American Society of Anesthesiologists Physical Status 3 or 4 in patients undergoing either intrathoracic or intra-abdominal surgery who were either aged >80 yr or underwent a procedure lasting >2 h. Cohorts were defined by reversal with neostigmine or sugammadex. The primary composite outcome was the occurrence of pneumonia or respiratory failure.

resultsAfter matching by institution, sex, age (within 5 yr), body mass index, anatomic region of surgery, comorbidities, and neuromuscular blocking agent, 3817 matched pairs remained. The primary postoperative pulmonary complications outcome occurred in 224 neostigmine cases vs 100 sugammadex cases (5.9% vs 2.6%, odds ratio 0.41, P<0.01). After adjustment for unbalanced covariates, the adjusted odds ratio for the association between sugammadex use and the primary outcome was 0.39 (P<0.0001).

conclusionsIn a cohort of patients at increased risk for pulmonary complications compared with neostigmine, use of sugammadex was independently associated with reduced risk of subsequent development of pneumonia or respiratory failure.

Indexed as

Neuromuscular BlockadeNeuromuscular Blocking AgentsRespiratory InsufficiencyCholinesterase InhibitorsCohort StudiesHumansNeostigminePostoperative ComplicationsRetrospective StudiesSugammadexCholinesterase InhibitorsNeostigmineNeuromuscular Blocking AgentsSugammadexneostigmineneuromuscular blocking drugpneumoniapostoperative pulmonary complicationsrespiratory failurereversal of neuromuscular blocksugammadex

Identifiers

PMID35691703
PMCPMC9875908
OpenAlexW4282917930

What OpenQuestion holds

Textmetadata
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.