Effect of Changing Estimated Glomerular Filtration Rate Formula on Sugammadex Use and Pulmonary Complications for African American and non-African American Patients.

IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Anesthesia and analgesia Pub Date : 2024-11-01 Epub Date: 2024-10-21 DOI:10.1213/ANE.0000000000006896
Milo Engoren, Michael Heung
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引用次数: 0

Abstract

Background: Sugammadex is associated with fewer postoperative pulmonary complications than is neostigmine reversal of neuromuscular blockade. However, the Food and Drug Administration-approved package insert states that its use is "not recommended" in severe renal impairment, separately defined as creatinine clearance <30 mL/min. Recently, the formula for estimating glomerular filtration rate (GFR) was updated to remove the race variable. Compared to the prior formula, the new consensus equation lowers the estimated GFR for African American patients and raises it for everyone else. We sought to determine how this change could differently impact the use of sugammadex, and thus the rate of pulmonary complications, for both African American and non-African American patients.

Methods: We used Monte Carlo simulation models to estimate the difference in pulmonary complications that would be suffered by patients when the change in creatine clearance calculated from the estimated GFR (using the old race-based and new race-neutral Chronic Kidney Disease Epidemiology Collaboration formulas) crossed the 30 mL/min threshold, which would require a change in sugammadex or neostigmine use.

Results: We found that 0.22% (95% confidence interval 0.14%-0.36%) of African American patients' creatinine clearance would drop from above to below 30 mL/min making sugammadex not recommended and 0.19% (0.16%-0.22%) of non-African American patients would have creatinine clearance increase to >30 mL/min making sugammadex now recommended. Based on our model, we estimate that African American patients would suffer (count [95% confidence interval]) 3 [0.4-6] more pulmonary complications per 100,000 African American patients who received rocuronium or vecuronium through the change from sugammadex to neostigmine reversal to comply with labeling recommendations. Conversely, the same change in formulas would reduce the number of non-African American patients suffering pulmonary complications by 3 [2-4] per 100,000.

Conclusions: The recent change in GFR formulas may potentially be associated with an increase in postoperative pulmonary complications in African American patients and a decrease in postoperative pulmonary complications in non-African American patients through GFR-driven changes in sugammadex use.

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改变估算肾小球滤过率公式对非裔美国人和非裔美国人患者使用舒降之痛和肺部并发症的影响。
背景:与新斯的明逆转神经肌肉阻滞相比,舒甘麦得的术后肺部并发症更少。然而,美国食品和药物管理局批准的包装说明书指出,"不建议 "在严重肾功能损害(肌酐清除率单独定义)的情况下使用舒格迈司:我们使用蒙特卡洛模拟模型来估算当根据估算的 GFR(使用基于种族的旧公式和基于种族中立的慢性肾脏病流行病学协作组织新公式)计算出的肌酸清除率变化超过 30 mL/min 临界值时,患者所患肺部并发症的差异,这将需要改变苏甘麦丁或新斯的明的使用:我们发现,0.22%(95% 置信区间为 0.14%-0.36%)的非裔美国患者的肌酐清除率将从高于 30 毫升/分钟降至低于 30 毫升/分钟,因此不推荐使用苏麦丁,0.19%(0.16%-0.22%)的非裔美国患者的肌酐清除率将升至高于 30 毫升/分钟,因此现在推荐使用苏麦丁。根据我们的模型,我们估计每 100,000 名接受罗库溴铵或维库溴铵治疗的非裔美国患者中,如果为遵守标签建议而将苏加麦司改为新斯的明逆转,非裔美国患者的肺部并发症将增加 3 [0.4-6] 例(计数[95% 置信区间])。相反,同样的配方改变会使每 10 万名非裔美国人患者中出现肺部并发症的人数减少 3 [2-4]:结论:近期 GFR 计算公式的变化可能与非裔美国人患者术后肺部并发症的增加有关,而非裔美国人患者术后肺部并发症的减少则与 GFR 驱动的舒格迈司使用变化有关。
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来源期刊
Anesthesia and analgesia
Anesthesia and analgesia 医学-麻醉学
CiteScore
9.90
自引率
7.00%
发文量
817
审稿时长
2 months
期刊介绍: Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.
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