title: Neuromuscular blockade, reversal agent use, and operating room time: retrospective analysis of US inpatient surgeries.
abstract: OBJECTIVE
  Reducing operating room (OR) time is of interest to hospital administrators because of high costs of OR utilization. Neuromuscular blocking agents (NMBAs) induce muscle relaxation during surgery. Several acetylcholinesterase inhibitors are used to reverse neuromuscular blockade to shorten recovery time. This study explored the relationship between elapsed OR time and the use of specific NMBAs and reversal agents among patients undergoing selected surgeries based on data from two large hospitals. Specifically, this study sought to test the hypothesis that the application of reversal agents in surgeries using a neuromuscular block would be associated with a decrease in elapsed OR time.
  
  
  METHODS
  This retrospective cohort study used clinical data from two large hospitals. The authors selected seven types of surgical cases involving thoracic, cardiac, vascular, abdominal, peripheral, urological, and neurological systems. Eligible cases were elective surgeries performed under general anesthesia and using one or more NMBAs (including rocuronium, vecuronium, cisatracurium, and/or pancuronium). Multivariate linear regressions were conducted to examine the relationships among neuromuscular blockade, reversal agent use (including neostigmine, pyridostigmine, and edrophonium), and elapsed OR time by controlling for age, gender, and patient comorbidities.
  
  
  RESULTS
  A total of 9670 surgeries were included in this analysis. The mean elapsed OR time across all surgeries was 227 min, and vecuronium was the most commonly used NMBA. Approximately 67% of all surgeries used a reversal agent. After controlling for confounding factors, use of a reversal agent was shown to be associated with the reduction of elapsed OR time in six of seven types of surgery. The magnitude of this effect ranged from 12 to 46 min of OR time saved. The exception was thoracic surgeries, for which use of a reversal agent was shown to be associated with longer OR time (approximately 26 min). Multivariate regression analyses revealed that the type of NMBA used was also a significant predictor of elapsed time for all surgeries (except cardiac).
  
  
  CONCLUSIONS
  This analysis has shown that use of selected neuromuscular blockade reversal agents may lead to more efficient OR resource use.
authors.affiliation: Boston Health Economics, Inc., 20 Fox Road, Waltham, MA 02451, USA.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.forename: David L
authors.initials: DL
authors.lastname: Hepner
authors.forename: Mary Helen
authors.initials: MH
authors.lastname: Tran
authors.forename: Mark
authors.initials: M
authors.lastname: Friedman
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Korn
authors.forename: Joseph
authors.initials: J
authors.lastname: Menzin
mesh_terms: D000368:Aged; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000592:standards*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage* / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use; D009873:Operating Rooms; D018579:Patient Selection; D012044:Regression Analysis; D012189:Retrospective Studies; D012984:Software; D013514:Surgical Procedures, Operative / Q000592:standards*; D013997:Time Factors; D014673:Vecuronium Bromide / Q000627:therapeutic use
chemical_list: D002800:Cholinesterase Inhibitors; D009466:Neuromuscular Blocking Agents; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide