Impact of Sugammadex Versus Neostigmine/Glycopyrrolate on Perioperative Efficiency

Abstract

Purpose

Neuromuscular blockade in the operating room necessitates the utilization of reversal agents to accelerate postoperative recovery and sustain operating room patient throughput. Cholinesterase inhibitors represent the historical standard of care for neuromuscular blockade reversal within anesthesia practice. Sugammadex, a synthetic gamma-cyclodextrin, was introduced to the market with evidence of more rapid and predictable reversal of neuromuscular blockade compared to alternative agents. Higher medication acquisition costs have limited more extensive use of sugammadex compared to that of neostigmine/glycopyrrolate. The purpose of this study was to examine the impact of sugammadex versus neostigmine/glycopyrrolate on perioperative efficiency to validate medication acquisition cost value.

Methods

A retrospective investigation was performed of patients with a surgical procedure at Houston Methodist Hospital from July 31, 2017 through August 1, 2018. The primary endpoint was time from reversal medication administration to operating room exit. Patient-specific doses were assessed to calculate average medication acquisition costs. The economic benefits of sugammadex were measured through review of average operating room and postanesthesia care unit costs per minute.

Results

There were a total of 640 surgical cases at Houston Methodist Hospital eligible for inclusion into the research study. The time from medication administration to operating room exit was significantly faster for sugammadex compared to neostigmine/glycopyrrolate (P<0.001) upon univariate analysis. However, when measured with linear regression, the difference in operating room exit time between sugammadex and neostigmine/glycopyrrolate was no longer statistically significant (P=0.122). Medication acquisition cost review highlighted a difference of $178.20, favoring use of neostigmine/glycopyrrolate.

Conclusion

The utilization of sugammadex does not correlate to consequential time saved in the operating room or extrapolation to workflow capacity for increased surgical case volume. Consideration of the medication acquisition cost promotes more restrictive use of sugammadex to indications with clinical relevance.

Keywords:

• reversal
• neuromuscular blockade
• anesthesia
• pharmacoeconomics

Acknowledgments

Data acquisition was facilitated by Yung Tran, Applications Analyst in the Houston Methodist System Quality Operations and Analytics Department. Statistical analysis support was provided by David Putney, PharmD, MPH, BCPS.

Author Contributions

All of the authors contributed to the research design, data analysis, and drafting or revising of the article. The authors provided final approval of the version to be published and agree to be accountable for all aspects of the work.

Disclosure

The authors have declared no potential conflicts of interest. Funding was not received for this research study.