Perioperative medicine & outcomes
Improving Neuromuscular Monitoring Through Education-Based Interventions and Studying Its Association With Adverse Postoperative Outcomes: A Retrospective Observational Study
Authors' conclusion
Our education-based interventions were associated with both TOF utilization and 90-day mortality but were not associated with either the odds of PPCs or sugammadex dosing. TOF monitoring was associated with reduced odds of PPCs and 90-day mortality.
Study context
- Population
- Adults undergoing noncardiac surgery, February 1, 2020 through October 31, 2021
- Participants
- 19,422 cases
- Exposure
- Education-based interventions vs preintervention phase
- Outcome
- Frequency of TOF monitoring (immediate change and trend over time)
Methodological detailsinterrupted time-series analysis, adjusted for patient- and procedure-related characteristics and secular trends
- Interrupted time-series analysis
- Adjusted for patient- and procedure-related characteristics and secular trends
Main finding
As reported in the abstract
Frequency of TOF monitoring
Odds ratio (weekly trend) (95% CI)
Preinterventionupward trend 0.5% per week
1.005(1.002–1.007)
Per week, as printed
Estimate (95% CI)P value
Phase 1 vs Preinterventionjoint Wald test
OR (immediate change) 1.54(1.33–1.79)
P < 0.001Phase 1 vs Preinterventiontrend OR to 1.035, or 3.5% per week; joint Wald test
OR (trend change) 1.03(1.01–1.05)
P < 0.001Phase 2 vs Phase 1joint test
OR (immediate change) 1.29(1.02–1.64)
P = 0.04Phase 2 vs Phase 1not significant; joint test
OR (trend change) 0.96(0.93–1.01)
P = 0.04- Cases with documented train-of-four (TOF) monitoring
- 11,636 (59.9%)
- Monitoring frequency, first week of preintervention
- 44.2%
- Monitoring frequency, final week of postintervention
- 83.4%
Observational data: associations, not effects.
Further findings
| Outcome | OR (trend change) (95% CI) | P value | |
|---|---|---|---|
| 90-day mortality (weekly trend) · 90 daysPhase 2 vs Phase 1 | 1.24 (1.06–1.45) | P = 0.03 | |
| 90-day mortality (weekly trend) · 90 daysPostintervention vs Phase 3 · from 14% weekly increase to 6.2% weekly decrease; joint test | 0.82 (0.68–0.99) | P = 0.05 | |
| −1012Difference (linear scale) |
TOF monitoring vs no TOF monitoring: Postoperative pulmonary complications (PPCs), 90-day mortality, sugammadex dosing
| Estimate | ||
|---|---|---|
| TOF monitoring | OR (PPCs) 0.69 (95% CI 0.55–0.86) | |
| TOF monitoring | OR (90-day mortality) 0.79 (95% CI 0.63–0.98) | |
| 0.512Ratio (log scale) |
| Mean difference (sugammadex dosing) (95% CI) | ||
|---|---|---|
| TOF monitoring | −0.02 (−0.04 to 0.01) | |
| −0.06−0.04−0.0200.02Difference (linear scale) |
- 90-day mortality (weekly trend): from weekly decrease of 8% to weekly increase of 14%; joint test
PPCs and sugammadex administration
- Study phases not significantly associated with PPCs or sugammadex administration
Sensitivity analysis adjusted for TOF monitoring
- Similar associations between study initiatives and postoperative outcomes
Original publication
Improving Neuromuscular Monitoring Through Education-Based Interventions and Studying Its Association With Adverse Postoperative Outcomes: A Retrospective Observational Study. Anesth Analg. Published 16 February 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →