We read with the interest the report by Li et al. of their single-center retrospective registry analysis on reversal of neuromuscular blockade and postoperative pulmonary complications. No difference in the odds of postoperative pulmonary complications was observed between patients receiving sugammadex (4.2%) or neostigmine (5.9%) (adjusted odds ratio, 0.89; 95% CI, 0.65 to 1.22). This result is consistent with the largest prospective cohort study and the two small randomized controlled trials3,4  to date, but contrasts with a much larger multicenter retrospective registry analysis where sugammadex was reported to be superior to neostigmine. A large randomized controlled trial is clearly required to resolve this issue.

One reason for differences between the abovementioned studies may be inconsistency in the definition of the composite primary endpoint (table 1). Well-constructed composite endpoints summarize the...

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