Rapid Sequence Induction Practices and Outcomes in Abdominal Surgery Patients: A Multicenter Observational Cohort Study
Main finding · 30-day mortalityResult — go to the resultRelative risk 0.85 95% CI 0.67–1.09Authors' conclusion
Across institutions in the United States, rocuronium has been increasingly used for RSI, eventually overtaking succinylcholine. Rocuronium use was not associated with a different risk of mortality, hypoxia, pulmonary complications, or AKI.
Study context
- Population
- Adults undergoing abdominal surgery with rapid sequence induction (RSI), 13 US institutions, 2015–20229,352 (11.3%) RSI cases
- Participants
- 82,772 adults
- Exposure
- Rocuronium vs succinylcholine for RSI
- Outcome
- Mortality
- Follow-up
- 30 days
Methodological detailsMulticenter Perioperative Outcomes Group database, mixed-effects models, targeted maximum likelihood estimation
- Multicenter Perioperative Outcomes Group database
- Mixed-effects models
- Targeted maximum likelihood estimation
Main finding
30-day mortality
Relative risk
0.85
95% CI 0.67–1.09
Rocuronium vs Succinylcholine
RR 0.85 (95% CI 0.67–1.09)
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
| Outcome | RR (95% CI) | |
|---|---|---|
| Postinduction hypoxia | 1.04 (0.61–1.77) | |
| Pulmonary complications | 0.93 (0.81–1.06) | |
| AKI | 1.05 (0.84–1.31) | |
| 0.512Relative risk (log scale) |
Succinylcholine use among RSI cases over time
- Most common NMBA succinylcholine
- 70.5%
- Succinylcholine in RSI cases, 2015
- 85.4%
- Succinylcholine in RSI cases, 2022 (P < 0.0001), replaced by rocuronium
- 37.3%
Video laryngoscopy use, RSI vs non-RSI cases
- RSI cases
- 16.2%
- Non-RSI cases (P < 0.0001)
- 8.0%
Original publication
Rapid Sequence Induction Practices and Outcomes in Abdominal Surgery Patients: A Multicenter Observational Cohort Study. Anesthesiology. Published 8 June 2026. doi:10.
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