Short- and immediate-term outcomes after sugammadex versus neostigmine in patients with severe chronic kidney disease: A retrospective cohort study
Authors' conclusion
Sugammadex was not associated with a significantly increased risk of pulmonary, cardiovascular, or mortality outcomes compared with neostigmine in patients with severe CKD having elective gastrointestinal surgery.
Study context
- Population
- Adults with severe chronic kidney disease (CKD) having elective gastrointestinal surgery, TriNetX Research Network (mainly US), 2016–2024matched cohort
- Participants
- 5,690 vs 5,690
- Exposure
- Sugammadex vs neostigmine for reversal of rocuronium-based NMB
- Sugammadexn = 5,690
- Neostigminen = 5,690reference
- Outcome
- Composite pulmonary complications (CPCs)
- Follow-up
- 30 days
Methodological detailspropensity-score matched, multi-institutional database
- Propensity-score matched
- Multi-institutional database
Main finding
As reported in the abstract
CPCs
No significant difference between the groups for composite pulmonary complications (CPCs): 2.1% vs. 2.1%
HR 1.00
95% CI 0.78–1.29p = 0.983
Observational data: associations, not effects.
Secondary outcomes
Acute respiratory failure (ARF) · 30 days
- No significant difference between the groups for ARF: 1.8% vs. 1.8%
- HR 1.00 (95% CI 0.76-1.32), p = 0.984
Intensive care unit (ICU) admission · 30 days
- ICU admission numerically higher in the sugammadex group: 4.9% vs. 4.0%
- HR 1.23 (95% CI 1.04-1.47), p = 0.019
- Not significant after Bonferroni correction (adjusted significance threshold of p < 0.01)
All outcomes at 7 and 90 days
- No outcome reached statistical significance after Bonferroni correction at either time point
Safety
MACEs · 30 days
- No significant difference between the groups for MACEs: 3.1% vs. 3.1%
- HR 0.98 (95% CI 0.80-1.21), p = 0.849
Original publication
Short- and immediate-term outcomes after sugammadex versus neostigmine in patients with severe chronic kidney disease: A retrospective cohort study. J Clin Anesth. Published 5 February 2026. doi:10.
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