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Sugammadex Reduced the Incidence of Postoperative Pulmonary Complications in Susceptible Patients Identified by ARISCAT Risk Index: Systematic Review and Meta-analysis

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Abstract

Introduction

The efficacy of sugammadex on postoperative pulmonary complications (PPCs) in susceptible patients, compared with neostigmine, remains indeterminate. The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) Group Investigators proposed a risk index for the early identification of susceptible patients, with excellent externally validated discrimination ability. Meta-analytical techniques were applied to evaluate the efficacy of sugammadex on PPCs in patients with ARISCAT-defined risk factors.

Methods

The study is registered on PROSPERO, number CRD42021261156. We searched PubMed, Scopus, Embase, Cochrane library, GreyNet, and OpenGrey for eligible randomized controlled trials (RCTs) without restricting the language or year of publication.

Results

Twelve RCTs consisting of 1182 patients susceptible to PPCs were included. A robust reduction was observed on the incidence of PPCs in susceptible patients who received sugammadex [RR 0.66; 95% CI (0.54, 0.80), p < 0.01], with a low level of between-study heterogeneity (I2 = 45.98%; H2 = 1.85). Similar protective effects were also proved in avoiding residual neuromuscular block (NMB) [RR 0.25; 95% CI (0.11, 0.56); p < 0.01], atelectasis [RR 0.74; 95% CI (0.59, 0.95); p = 0.02], pneumonia [RR 0.49; 95% CI (0.28, 0.88); p = 0.02], and respiratory failure [RR 0.61; 95% CI (0.39, 0.96); p = 0.03]. No difference was observed regarding adverse events [RR 0.85; 95% CI (0.72, 1.01); p = 0.06].

Conclusion

Low to moderate quality of evidence demonstrated the edge of sugammadex over neostigmine for NMB reversal in reducing the likelihood of PPCs and residual NMB in patients with ARISCAT-defined risk factors. Clinicians may reassess the type of reversal agent when treating patients susceptible to PPCs.

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Acknowledgements

Funding

This study was funded by the National Key Research and Development Program of China (Grant No. 2018YFC2001903) and the National Natural Science Foundation of China (Grant No. 81873952) and the National Natural Science Foundation of China (Grant No. 81901948). The Rapid Service Fee was funded by the authors.

Author Contributions

All named authors were involved in study conception and design, material preparation, data collection and analysis. The first draft of the manuscript was written by Yun-Xiao Bai, Jing-Jing Han, Ke-Xuan Liu and Qing-Ping Wu, and all authors provided comments on subsequent drafts. All authors read and approved the final manuscript.

Disclosures

Yun-Xiao Bai, Jin-Jing Han, Jie Liu, Xia Li, Zhen-Zhen Xu, Yong Lv, Ke-Xuan Liu, Qing-Ping Wu have nothing to disclose.

Compliance with Ethics Guidelines

Since this article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors, no ethics committee approval is required for this study.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author notes

  1. Yun-Xiao Bai and Jing-Jing Han contributed equally to this work and share first authorship.

  2. Ke-Xuan Liu and Qing-Ping Wu contributed equally to this work and share last authorship.

Authors and Affiliations

  1. Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Yun-Xiao Bai, Jing-Jing Han, Jie Liu, Xia Li, Zhen-Zhen Xu, Yong Lv & Qing-Ping Wu

  2. Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China

    Ke-Xuan Liu

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Bai, YX., Han, JJ., Liu, J. et al. Sugammadex Reduced the Incidence of Postoperative Pulmonary Complications in Susceptible Patients Identified by ARISCAT Risk Index: Systematic Review and Meta-analysis. Adv Ther 40, 3784–3803 (2023). https://doi.org/10.1007/s12325-023-02535-9

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