BACKGROUND Reversing a neuromuscular blockade agent with sugammadex is known to lessen postoperative complications by reducing postoperative residual curarization. However, its effects on 90-day mortality are unknown. Therefore, this study aimed to compare the effects of sugammadex and neostigmine in terms of 90-day mortality after non-cardiac surgery. METHODS This retrospective cohort study analyzed the medical records of adult patients aged 18 years or older who underwent non-cardiac surgery at a single tertiary care hospital between 2011 and 2016. Propensity score matching and Cox regression analysis were used to investigate the effectiveness of sugammadex and neostigmine in lowering 90-day mortality after non-cardiac surgery. RESULTS A total of 65,702 patients were included in the analysis (mean age: 52.3 years, standard deviation: 15.7), and 23,532 of these patients (35.8%) received general surgery. After propensity score matching, 14,179 patients (3906 patients from the sugammadex group and 10,273 patients from the neostigmine group) were included in the final analysis. Cox regression analysis in the propensity score-matched cohort showed that the risk of 90-day mortality was 40% lower in the sugammadex group than in the neostigmine group (hazard ratio: 0.60, 95% confidence interval: 0.37, 0.98; P = 0.042). These results were similar in the multivariable Cox regression analysis of the entire cohort (hazard ratio: 0.62, 95% confidence interval: 0.39, 0.96; P = 0.036). CONCLUSIONS This retrospective cohort study suggested that reversing rocuronium with sugammadex might be associated with lower 90-day mortality after non-cardiac surgery compared to neostigmine. However, since this study did not evaluate quantitative neuromuscular function in the postoperative period due to its retrospective design, the results should be interpreted carefully. Future prospective studies with quantitative neuromuscular monitoring in the postoperative period should be performed to confirm these results.

中文翻译：

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非心脏手术后，sugammadex和新斯的明引起的神经肌肉逆转与90天死亡率相关。

背景技术已知用sugammadex逆转神经肌肉阻滞剂可通过减少术后残留的治愈来减轻术后并发症。但是，其对90天死亡率的影响尚不清楚。因此，本研究旨在比较非心脏手术后sugammadex和neostigmine的90天死亡率的影响。方法这项回顾性队列研究分析了2011年至2016年间在一家三级医院接受非心脏手术的18岁或18岁以上成人患者的病历。倾向得分匹配和Cox回归分析用于研究sugammadex和sugammadex的有效性。新斯的明降低非心脏手术后90天死亡率。结果分析共纳入65702例患者（平均年龄：52.3岁，标准差：15.7），其中23,532名患者（35.8％）接受了普外科手术。倾向得分匹配后，最终分析包括14179例患者（sugammadex组3906例患者和新斯的明组10273例患者）。在倾向得分匹配的队列中进行Cox回归分析表明，舒马吉德组的90天死亡风险比新斯的明组低40％（危险比：0.60，95％置信区间：0.37，0.98; P = 0.042 ）。在整个队列的多变量Cox回归分析中，这些结果相似（危险比：0.62，95％置信区间：0.39，0.96； P = 0.036）。结论这项回顾性队列研究表明，与新斯的明相比，罗舒溴铵与舒马葡糖逆转非心脏手术后90天死亡率可能更低。然而，由于该研究的回顾性设计，因此未在术后评估其定量的神经肌肉功能，因此应仔细解释其结果。术后应进行定量神经肌肉监测的前瞻性研究，以证实这些结果。