Validation of the REPS Prediction Tool



Status:Recruiting
Healthy:No
Age Range:18 - Any
Updated:1/18/2019
Start Date:June 29, 2018
End Date:December 2019
Contact:Matthias Eikermann, MD, PhD
Email:meikerma@bidmc.harvard.edu
Phone:(617) 726-3030

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Validation of the REPS Prediction Tool to Improve Quality of Perioperative Care

Neuromuscular blocking agents' (NMBA) use during surgery is associated with postoperative
respiratory complications and increased risk of readmission to the hospital following
ambulatory surgery. Residual neuromuscular block (rNMB) after surgery is difficult to
identify. We have recently developed the REsidual neuromuscular block Prediction Score
(REPS), that predicts the risk for postoperative rNMB. Our primary objective is now to
validate this prediction tool using Beth Israel Deaconess Medical Center/BIDMC's data.

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
We found this trial at
1
site
330 Brookline Ave
Boston, Massachusetts 02215
617-667-7000
Phone: 617-726-3030
Beth Israel Deaconess Medical Center Beth Israel Deaconess Medical Center (BIDMC) is one of the...
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