Association between intraoperative non-depolarising neuromuscular blocking agent dose and 30-day readmission after abdominal surgery

T. Thevathasan, S. L. Shih, K. C. Safavi, D. L. Berger, S. M. Burns, S. D. Grabitz, R. S. Glidden, R. D. Zafonte, M. Eikermann, J. C. Schneider

Research output: Contribution to journalArticlepeer-review

51 Scopus citations


Background We hypothesised that intraoperative non-depolarising neuromuscular blocking agent (NMBA) dose is associated with 30-day hospital readmission. Methods Data from 13,122 adult patients who underwent abdominal surgery under general anaesthesia at a tertiary care hospital were analysed by multivariable regression, to examine the effects of intraoperatively administered NMBA dose on 30-day readmission (primary endpoint), hospital length of stay, and hospital costs. Results Clinicians used cisatracurium (mean dose [SD] 0.19 mg kg -1 [0.12]), rocuronium (0.83 mg kg -1 [0.53]) and vecuronium (0.14 mg kg -1 [0.07]). Intraoperative administration of NMBAs was dose-dependently associated with higher risk of 30-day hospital readmission (adjusted odds ratio 1.89 [95% Confidence Interval (CI) 1.26-2.84] for 5th quintile vs 1st quintile; P for trend: P<0.001), prolonged hospital length of stay (adjusted incidence rate ratio [aIRR] 1.20 [95% CI 1.11-1.29]; P for trend: P<0.001) and increased hospital costs (aIRR 1.18 [95% CI 1.13-1.24]; P for trend: P<0.001). Admission type (same-day vs inpatient surgery) significantly modified the risk (interaction term: aOR 1.31 [95% CI 1.05-1.63], P=0.02), and the adjusted odds of readmission in patients undergoing ambulatory surgical procedures who received high-dose NMBAs vs low-dose NMBAs amounted to 2.61 [95% CI 1.11-6.17], P for trend: P<0.001. Total intraoperative neostigmine dose increased the risk of 30-day readmission (aOR 1.04 [1.0-1.08], P=0.048). Conclusions In a retrospective analysis, high doses of NMBAs given during abdominal surgery was associated with an increased risk of 30-day readmission, particularly in patients undergoing ambulatory surgery.

Original languageEnglish (US)
Pages (from-to)595-605
Number of pages11
JournalBritish Journal of Anaesthesia
Issue number4
StatePublished - Oct 1 2017
Externally publishedYes


  • ambulatory surgery
  • general surgery
  • hospital readmission
  • neuromuscular blocking agents

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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