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Abstract
Objective
The aim of the study is to evaluate the clinical and economic impact of introducing a rocuronium–neostigmine–sugammadex strategy into a cisatracurium–neostigmine regimen for neuromuscular block (NMB) management.
Methods
We conducted a retrospective analysis of clinical outcomes and cost-effectiveness in five operating rooms at University Hospital of Padova. A clinical outcome evaluation after sugammadex administration as first-choice reversal drug in selected patients (rocuronium–sugammadex) and as rescue therapy after neostigmine reversal (rocuronium–neostigmine–sugammadex) compared to control was performed. A cost-analysis of NMB management accompanying the introduction of a rocuronium–neostigmine–sugammadex strategy into a cisatracurium–neostigmine regimen was carried out. To such purpose, two periods were compared: 2011–2012, without sugammadex available; 2013–2014, with sugammadex available. A subsequent analysis was performed to evaluate if sugammadex replacing neostigmine as first choice reversal drug is cost-effective.
Results
The introduction of a rocuronium–neostigmine–sugammadex strategy into a cisatracurium–neostigmine regimen reduced the average cost of NMB management by 36%, from €20.8/case to €13.3/case. Patients receiving sugammadex as a first-choice reversal drug (3%) exhibited significantly better train-of-four ratios at extubation (P<0.001) and were discharged to the surgical ward (P<0.001) more rapidly than controls. The cost-saving of sugammadex as first-choice reversal drug has been estimated to be €2.9/case. Patients receiving sugammadex as rescue therapy after neostigmine reversal (3.2%) showed no difference in time to discharge to the surgical ward (P=0.44) compared to controls. No unplanned intensive care unit (ICU) admissions with rocuronium–neostigmine–sugammadex strategy were observed. The potential economic benefit in avoiding postoperative residual curarization (PORC)-related ICU admission in the 2013–2014 period was estimated at an average value of €13,548 (€9,316–€23,845).
Conclusion
Sugammadex eliminated PORC and associated morbidities. In our center, sugammadex reduced the costs of NMB management and promoted rapid turnover of patients in operating rooms, with total cost-effectiveness that counteracts the disadvantages of its high cost.
Acknowledgments
The authors would like to thank Dr S Boccella, Head of Nurse of Padova Hospital, for invaluable support in the acquisition of data; Dr C Battistuta, staff member of Pharmacy of Padova Hospital, for important contributions in the acquisition of data; and Dr A Marcolongo and Dr L Furlan, staff members of Administration of Padova Hospital, for indispensable support with the economic assessment.
Author contributions
MC has made contributions to conception and design of the study, acquisition of data, analysis and interpretation of data, and drafting and revising the manuscript.
FB has made contributions to conception and design of the study, acquisition and interpretation of data, and revising the manuscript.
FZ has made contributions to acquisition and interpretation of data, and revising the manuscript.
CO has made contributions to conception and design of the study, analysis and interpretation of data, and revising the manuscript.
All authors agree on all aspects of the work, and read and approved the final paper.
Disclosure
MC, FB, and CO have received payments for lectures from Merck Sharp and Dohme (MSD), Italy. The authors report no other conflicts of interest in this work.