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Comparison of Clinical Effectiveness Between Ambroxol and N-Acetylcysteine in Surgical Patients: A Retrospective
Jiaming Bian1, Hong Liang1, Mei Zhang1
1Department of Pharmacology, The 7th Medical Center of Chinese PLA General Hospital, Beijing, China.
Abstract:
Postoperative pulmonary complications (PPCs) are a major cause of postoperative morbidity, mortality, and longer hospital stays. Expectorants are widely used during the perioperative period to reduce PPCs. This study aimed to compare the clinical effectiveness between ambroxol (AMB) and N-acetylcysteine (NAC) in patients undergoing surgery. A multicenter, retrospective cohort study was conducted using deidentified medical records from hospital information system. Between July 1, 2015, and November 30, 2017, patients aged ≥18 years, who received intravenous AMB or nebulized NAC as the only expectorant therapy for >3 days during their hospitalization for thoracic, abdominal, and neurosurgery, were included in this study. The clinical outcomes were evaluated, and propensity score matching was used to adjust significant differences between 2 groups. A total of 4025 cases in the AMB group and 2062 in NAC group after propensity score matching were identified. The incidence of PPCs (13.9% vs 11.6%; P = .013), postoperative sputum suction (17.2% vs 8.0%; P < .001), intensive care unit admission after surgery (25.1% vs 22.5%; P = .024), and postoperative mechanical ventilation (22.3% versus 17.5%; P < .001) in the AMB group were all significantly higher than those in the NAC group. This study suggested that patients treated with NAC during the perioperative period had a significantly lower risk of PPCs. However, further prospective study is needed to ensure the replicability of our findings.
Insights
N-acetylcysteine (NAC) significantly reduced postoperative pulmonary complications (PPCs) compared to ambroxol (AMB). NAC therapy is associated with lower risks of PPCs, sputum suction, and ICU admission in surgical patients.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Pulmonology
- Pharmacology
Background:
- Postoperative pulmonary complications (PPCs) are a significant cause of patient morbidity and mortality.
- Expectorants are commonly used to mitigate PPCs during the perioperative period.
- Comparing the efficacy of different expectorants like ambroxol (AMB) and N-acetylcysteine (NAC) is crucial for optimizing patient care.
Purpose of the Study:
- To compare the clinical effectiveness of ambroxol (AMB) and N-acetylcysteine (NAC) in reducing PPCs.
- To evaluate the impact of these expectorants on other postoperative outcomes.
- To provide evidence-based recommendations for perioperative expectorant therapy.
Main Methods:
- A multicenter, retrospective cohort study utilizing deidentified medical records.
- Inclusion criteria: patients aged ≥18 years receiving AMB or nebulized NAC for >3 days during hospitalization for thoracic, abdominal, or neurosurgery.
- Propensity score matching was employed to control for confounding variables between the AMB and NAC groups.
Main Results:
- After propensity score matching, 4025 cases in the AMB group and 2062 in the NAC group were analyzed.
- The incidence of PPCs was significantly lower in the NAC group (11.6%) compared to the AMB group (13.9%) (P = .013).
- NAC group also showed significantly lower rates of postoperative sputum suction, ICU admission, and mechanical ventilation.
Conclusions:
- Perioperative treatment with N-acetylcysteine (NAC) is associated with a significantly lower risk of postoperative pulmonary complications.
- NAC demonstrates superior clinical effectiveness compared to ambroxol (AMB) in this surgical patient cohort.
- Further prospective studies are warranted to confirm these findings and their clinical implications.
