Comparison of Sugammadex Versus Neostigmine for Postoperative Outcomes in Coronavirus Disease 2019 Patients Undergoing Thoracic Surgery: A Cohort Study.

Abstract

Objective: This study was designed to evaluate whether the use of sugammadex was associated with a lower incidence of pulmonary complications than neostigmine in patients with coronavirus disease 2019 (COVID-19) undergoing thoracic surgery.

Design: This was a matched cohort study using data from the TriNetX database.

Setting: Operating room.

Participants: Adult patients with COVID-19 within 6 weeks before thoracic surgery.

Intervention: The use of sugammadex or neostigmine to reverse muscular blockade.

Measurements and main results: Outcomes included the incidence of composite pulmonary complications (CPCs) (primary outcome), pneumonia, respiratory failure, need for intensive care, mortality, sepsis, and acute kidney injury at 30-day follow-up. The potential benefits of sugammadex were also assessed at 90-day follow-up. Predictors of pulmonary complications were identified in those receiving sugammadex. After matching, 985 patients were included in each group. At 30 days, the incidence of CPCs (5.69% v 9.75%; odds ratio [OR]: 0.56, p = 0.0009), pneumonia (1.83% v 4.37%; OR: 0.41, p = 0.0016), and respiratory failure (1.42% v 3.25%; OR: 0.43, p = 0.0087) were significantly lower with sugammadex than neostigmine. No differences were found in other 30-day outcomes. Diabetes and chronic obstructive pulmonary disease were identified as risk factors for pneumonia and respiratory failure. At 90 days, no significant differences were observed, although mortality tended to be lower with sugammadex.

Conclusion: In patients with COVID-19 undergoing thoracic surgery, sugammadex was associated with a reduction in 30-day postoperative pulmonary complications compared with neostigmine. However, this finding requires validation in larger, randomized trials.