Perioperative Medicine  |   November 2019
Effect of a Cognitive Aid on Reducing Sugammadex Use and Associated Costs: A Time Series Analysis
Author Notes
  • From the Department of Anesthesiology and Perioperative Medicine (D.M.D., R.S., A.T., R.J.A.), and the Department of Pharmacy (F.J.M.), Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
  • Submitted for publication January 16, 2019. Accepted for publication July 12, 2019.
    Submitted for publication January 16, 2019. Accepted for publication July 12, 2019.×
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    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Part of the work presented in this article has been presented as a poster at the Annual Meeting of the American Society of Anesthesiologists in San Francisco, California, October 16, 2018.
    Part of the work presented in this article has been presented as a poster at the Annual Meeting of the American Society of Anesthesiologists in San Francisco, California, October 16, 2018.×
  • Address correspondence to Dr. Drzymalski: Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, 800 Washington Street, Box 298, Tufts University School of Medicine, Boston, Massachusetts 02111. dandrzymalski@gmail.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Neuromuscular Diseases and Drugs / Pharmacology
Perioperative Medicine   |   November 2019
Effect of a Cognitive Aid on Reducing Sugammadex Use and Associated Costs: A Time Series Analysis
Anesthesiology 11 2019, Vol.131, 1036-1045. doi:10.1097/ALN.0000000000002946
Anesthesiology 11 2019, Vol.131, 1036-1045. doi:10.1097/ALN.0000000000002946
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Sugammadex provides rapid and effective reversal of neuromuscular blocks but is expensive

What This Article Tells Us That Is New:

  • The investigators tested the hypothesis that a cognitive aid to guide selective use of sugammadex reduced use

  • They conducted a segmented regression (interrupted time series) retrospective analysis before and after implementing the cognitive aid and informational meetings for their department

  • Sugammadex use and associated costs, which were increasing, decreased substantially after introduction of the cognitive aid

Background: The authors observed increased pharmaceutical costs after the introduction of sugammadex in our institution. After a request to decrease sugammadex use, the authors implemented a cognitive aid to help choose between reversal agents. The purpose of this study was to determine if sugammadex use changed after cognitive aid implementation. The authors’ hypothesis was that sugammadex use and associated costs would decrease.

Methods: A cognitive aid suggesting reversal agent doses based on train-of-four count was developed. It was included with each dispensed reversal agent set and in medication dispensing cabinet bins containing reversal agents. An interrupted time series analysis was performed using pharmaceutical invoices and anesthesia records. The primary outcome was the number of sugammadex administrations. Secondary outcomes included total pharmaceutical acquisition costs of neuromuscular blocking drugs and reversal agents, adverse respiratory events, emergence duration, and number of neuromuscular blocking drug administrations.

Results: Before cognitive aid implementation, the number of sugammadex administrations was increasing at a monthly rate of 20 per 1,000 general anesthetics (P < 0.001). Afterward, the monthly rate was 4 per 1,000 general anesthetics (P = 0.361). One month after cognitive aid implementation, the number of sugammadex administrations decreased by 281 per 1,000 general anesthetics (95% CI, 228 to 333, P < 0.001). In the final study month, there were 509 fewer sugammadex administrations than predicted per 1,000 general anesthetics (95% CI, 366 to 653; P < 0.0001), and total pharmaceutical acquisition costs per 1,000 general anesthetics were $11,947 less than predicted (95% CI, $4,043 to $19,851; P = 0.003). There was no significant change in adverse respiratory events, emergence duration, or administrations of rocuronium, vecuronium, or atracurium. In the final month, there were 75 more suxamethonium administrations than predicted per 1,000 general anesthetics (95% CI, 32 to 119; P = 0.0008).

Conclusions: Cognitive aid implementation to choose between reversal agents was associated with a decrease in sugammadex use and acquisition costs.