Anesth Pain Med.  2022 Oct;17(4):371-380. 10.17085/apm.22189.

Postoperative mortality in patients with end-stage renal disease according to the use of sugammadex: a single-center retrospective propensity score matched study

• Song S
• Cho HB
• Park SY
• Koo WM
• Choi SJ
• Yoon S
• Park S
• Yoo JH
• Kim MG
• Chung JW
• Kim SH

• KMID: 2535335
• DOI: http://doi.org/10.17085/apm.22189

Abstract

excretion. There are restrictions on the use of sugammadex in patients with severe renal impairment. A paucity of data supports the clinical safety of sugammadex in patients with renal impairment. We analyzed mortality after using sugammadex in patients with end-stage renal disease to establish evidence of safety for sugammadex.
Methods
We retrospectively collected the medical records of 2,134 patients with end-stage renal disease who were dependent on hemodialysis and underwent surgery under general anesthesia between January 2018 and December 2019. Propensity score matching was used. The primary outcome was the 30-day mortality rate, and secondary outcomes were the 1-year mortality rate and causes of death.
Results
A total of 2,039 patients were included in the study. Sugammadex was administered as a reversal agent for rocuronium in 806 (39.5%) patients; the remaining 1,233 (60.5%) patients did not receive sugammadex. After matching, 1,594 patients were analyzed; 28 (3.5%) of the 797 patients administered sugammadex, and 28 (3.5%) of the 797 patients without sugammadex, died within 30 days after surgery (P > 0.99); 38 (4.8%) of the 797 patients administered sugammadex, and 45 (5.7%) of the 797 patients without sugammadex, died within 1 year after surgery (P = 0.499). No significant differences in the causes of 30-day mortality were observed between the two groups after matching (P = 0.860).
Conclusions
In this retrospective study, sugammadex did not increase the 30-day and 1-year mortality rate after surgery in end-stage renal disease patients.

Keyword

Dialysis; End-stage renal disease; Mortality; Neuromuscular blockade; Sugammadex

Figure

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  Fig. 1. Flow chart of the study. ESRD: end-stage renal disease.

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  Fig. 2. Comparison of the causes of 30-day mortality between the sugammadex and non-sugammadex groups before and after matching. It is difficult to differentiate the difference in distribution according to whether sugammadex is administered.

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