Effect of sugammadex on postoperative pulmonary complications in patients undergoing video-assisted thoracoscopic lung surgery.

BACKGROUND

Postoperative pulmonary complications (PPCs) remain common after video-assisted thoracoscopic (VATS) lung surgery. Whether sugammadex reduces the incidence of PPCs compared with traditional antagonists remains uncertain. This meta-analysis aimed to evaluate the impact of sugammadex on PPCs in patients undergoing VATS pulmonary resection.

METHODS

This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020). PubMed, Web of Science, Cochrane Library, and CNKI were searched from inception to December 13, 2024. Randomized controlled trials (RCTs) and cohort studies comparing sugammadex with other antagonists (e.g., neostigmine or pyridostigmine) in patients undergoing VATS pulmonary resection were included. The primary outcome was overall PPCs. Risk of bias was assessed using the Cochrane risk-of-bias tool for RCTs and the Newcastle-Ottawa Scale (NOS) for cohort studies. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using fixed- or random-effects models according to heterogeneity.

RESULTS

Nine studies involving 2,240 patients were included, of which eight reported data on overall PPCs and were included in the primary meta-analysis. Sugammadex significantly reduced the incidence of overall PPCs compared with control agents (OR = 0.68, 95% CI: 0.58-0.80, P < 0.001; I² = 23.9%). Subgroup analyses stratified by study design, type of resection, and disease showed consistent results. Among specific PPCs, sugammadex was associated with a lower risk of atelectasis (OR = 0.61, 95% CI: 0.47-0.80, P < 0.001), whereas no significant differences were observed for pneumonia or other complications.

CONCLUSIONS

Sugammadex may effectively reduce the risk of PPCs, particularly atelectasis, in patients undergoing VATS pulmonary resection. Further large-scale, high-quality studies are warranted.