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- Publisher Website: 10.1111/anae.14326
- Scopus: eid_2-s2.0-85050407180
- PMID: 29974459
- WOS: WOS:000442206900004
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Article: Implementation of a new strategy to improve the peri-operative management of neuromuscular blockade and its effects on postoperative pulmonary complications
Title | Implementation of a new strategy to improve the peri-operative management of neuromuscular blockade and its effects on postoperative pulmonary complications |
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Authors | |
Keywords | neostigmine: dose rationale neuromuscular block: assessment patient care quality measures |
Issue Date | 2018 |
Publisher | Wiley-Blackwell Publishing Ltd. The Journal's web site is located at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2044 |
Citation | Anaesthesia, 2018, v. 73 n. 9, p. 1067-1078 How to Cite? |
Abstract | Inappropriate dosing of neostigmine for antagonism of neuromuscular blockade has been associated with postoperative pulmonary complications. We evaluated the effects of a quality improvement initiative tailored to optimise the use of neostigmine in antagonising neuromuscular blockade on postoperative pulmonary complications, costs and duration of hospital stay. The quality improvement initiative consisted of: a reduction in available neostigmine aliquot sizes; a cognitive aid; an educational component; and a financial incentive for the intra-operative documentation of train-of-four measurement before administration of neostigmine. We conducted a pre-specified analysis of data obtained in our quality improvement study. Additional analyses were conducted in a propensity-matched cohort. An interrupted time series design was used to discriminate between the intervention and a counterfactual scenario. We analysed 12,025 consecutive surgical cases performed in 2015. Postoperative pulmonary complications occurred in 220 (7.5%) of 2937 cases pre-intervention and 568 (6.3%) of 9088 cases post-intervention. Adjusted regression analyses showed significantly a lower risk of postoperative pulmonary complications (OR 0.73 (95%CI 0.61–0.88); p = 0.001), lower costs (incidence rate ratio 0.95 (95%CI 0.93–0.97); p < 0.001) and shorter duration of hospital stay (incidence rate ratio 0.91 (95%CI 0.87–0.94); p < 0.001) after implementation of the quality improvement initiative. Analyses in a propensity-matched sample (n = 2936 per group) and interrupted time series analysis (n = 27,202 cases) confirmed the findings. Our data show that a local, multifaceted quality improvement initiative can enhance the quality of intra-operative neuromuscular blocking agent utilisation, thereby reducing the incidence of postoperative pulmonary complications. © 2018 Association of Anaesthetists |
Persistent Identifier | http://hdl.handle.net/10722/272931 |
ISSN | 2021 Impact Factor: 12.893 2020 SCImago Journal Rankings: 1.839 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Rudolph, MI | - |
dc.contributor.author | Chitilian, HV | - |
dc.contributor.author | Ng, PY | - |
dc.contributor.author | Timm, FP | - |
dc.contributor.author | Agarwala, AV | - |
dc.contributor.author | Doney, AB | - |
dc.contributor.author | Ramachandran, SK | - |
dc.contributor.author | Houle, TT | - |
dc.contributor.author | Eikermann, M | - |
dc.date.accessioned | 2019-08-06T09:19:17Z | - |
dc.date.available | 2019-08-06T09:19:17Z | - |
dc.date.issued | 2018 | - |
dc.identifier.citation | Anaesthesia, 2018, v. 73 n. 9, p. 1067-1078 | - |
dc.identifier.issn | 0003-2409 | - |
dc.identifier.uri | http://hdl.handle.net/10722/272931 | - |
dc.description.abstract | Inappropriate dosing of neostigmine for antagonism of neuromuscular blockade has been associated with postoperative pulmonary complications. We evaluated the effects of a quality improvement initiative tailored to optimise the use of neostigmine in antagonising neuromuscular blockade on postoperative pulmonary complications, costs and duration of hospital stay. The quality improvement initiative consisted of: a reduction in available neostigmine aliquot sizes; a cognitive aid; an educational component; and a financial incentive for the intra-operative documentation of train-of-four measurement before administration of neostigmine. We conducted a pre-specified analysis of data obtained in our quality improvement study. Additional analyses were conducted in a propensity-matched cohort. An interrupted time series design was used to discriminate between the intervention and a counterfactual scenario. We analysed 12,025 consecutive surgical cases performed in 2015. Postoperative pulmonary complications occurred in 220 (7.5%) of 2937 cases pre-intervention and 568 (6.3%) of 9088 cases post-intervention. Adjusted regression analyses showed significantly a lower risk of postoperative pulmonary complications (OR 0.73 (95%CI 0.61–0.88); p = 0.001), lower costs (incidence rate ratio 0.95 (95%CI 0.93–0.97); p < 0.001) and shorter duration of hospital stay (incidence rate ratio 0.91 (95%CI 0.87–0.94); p < 0.001) after implementation of the quality improvement initiative. Analyses in a propensity-matched sample (n = 2936 per group) and interrupted time series analysis (n = 27,202 cases) confirmed the findings. Our data show that a local, multifaceted quality improvement initiative can enhance the quality of intra-operative neuromuscular blocking agent utilisation, thereby reducing the incidence of postoperative pulmonary complications. © 2018 Association of Anaesthetists | - |
dc.language | eng | - |
dc.publisher | Wiley-Blackwell Publishing Ltd. The Journal's web site is located at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2044 | - |
dc.relation.ispartof | Anaesthesia | - |
dc.rights | This is the peer reviewed version of the following article: [FULL CITE], which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. | - |
dc.subject | neostigmine: dose rationale | - |
dc.subject | neuromuscular block: assessment | - |
dc.subject | patient care | - |
dc.subject | quality measures | - |
dc.title | Implementation of a new strategy to improve the peri-operative management of neuromuscular blockade and its effects on postoperative pulmonary complications | - |
dc.type | Article | - |
dc.identifier.email | Ng, PY: pyeungng@hku.hk | - |
dc.identifier.authority | Ng, PY=rp02517 | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1111/anae.14326 | - |
dc.identifier.pmid | 29974459 | - |
dc.identifier.scopus | eid_2-s2.0-85050407180 | - |
dc.identifier.hkuros | 300516 | - |
dc.identifier.volume | 73 | - |
dc.identifier.issue | 9 | - |
dc.identifier.spage | 1067 | - |
dc.identifier.epage | 1078 | - |
dc.identifier.isi | WOS:000442206900004 | - |
dc.publisher.place | United Kingdom | - |
dc.identifier.issnl | 0003-2409 | - |