Validation of the REPS Prediction Tool

Residual neuromuscular blockade occurs in about 20-60% of patients and depends on compound
and dose of NMBA reversal agent used. While on the one hand, NMBAs optimize surgical
conditions and facilitate mechanical ventilation in patients with ventilator asynchrony, on
the other hand, these agents have been associated with respiratory complications and
increased risk of readmission after ambulatory surgery. A consensus in regard to guidelines
and thresholds to define the optimal strategy to optimize surgical conditions is yet to be
achieved. We have shown that utilization of non-depolarizing muscle relaxants and their
reversal agents can be improved by dedicated quality improvement techniques. We have also
recently developed the REPS, a tool that predicts postoperative rNMB.

This is a retrospective, observational, cohort study based on on-file hospital data from Beth
Israel Deaconess Medical Center, Boston, Massachusetts.

The primary aim is to validate the REPS with BIDMC data. The investigators will utilize the
pre-defined variables identified to predict residual neuromuscular blockade at BIDMC.

A dichotomized REPS (high-risk versus low-risk for rNMB which corresponds to a REPS >4 and
<4, respectively) will be validated for clinical outcomes, such as postoperative respiratory
complications, 30-day hospital readmission and hospital length of stay.

Inclusion Criteria:

- 18 years or older

- Non-cardiac surgery

- General anesthesia with intermediate-acting NMBAs (atracurium, cisatracurium,
vecuronium, or rocuronium)

- PACU after surgery

Exclusion Criteria:

- American Society of Anesthesiology (ASA) Physical Status Classification of 5 or 6

- Missing last covariates