Sugammadex versus no pharmacological reversal under quantitative neuromuscular monitoring: a propensity score-matched analysis of postoperative pulmonary complications.

purposeSugammadex may reduce postoperative pulmonary complications (PPCs). However, its association with PPCs remains unclear when quantitative neuromuscular monitoring (NMT) is routinely used, and comparisons with spontaneous recovery are limited. We compared PPCs between cases receiving sugammadex and those receiving no reversal agent.

methodsWe included adult noncardiac surgical cases from 2010 through 2020. Eligible cases involved rocuronium administration and removal of the airway device in the operating room. The primary outcome was postoperative pneumonia within 30 days. Secondary outcomes were respiratory failure, ventilatory support, reintubation, and mortality within 30 days. One-to-one propensity score matching was performed using patient characteristics and intraoperative factors. Outcomes were compared using conditional logistic regression. We also evaluated achievement of a train-of-four (TOF) ratio ≥0.9 at airway-device removal and performed a supplementary propensity score-matched analysis restricted to cases meeting this threshold.

resultsAfter matching, each group included 5677 of the 26,621 eligible cases. Postoperative pneumonia occurred in 72 cases (1.3%) in the no-reversal group and 87 (1.5%) in the sugammadex group, with no significant between-group difference (odds ratio [OR], 1.22; 95% confidence interval [CI], 0.89-1.69; P = 0.22); no secondary outcome differed significantly between groups. Achievement of a TOF ratio ≥0.9 was more frequent in the sugammadex group. The supplementary analysis likewise showed no significant between-group differences.

conclusionUnder routine quantitative NMT, sugammadex administration was associated with more frequent achievement of a TOF ratio ≥0.9 but not with lower incidences of postoperative pneumonia or secondary outcomes.