Impact of Sugammadex Versus Neostigmine/Glycopyrrolate on Perioperative Efficiency

Figures & data

Table 1 Baseline Characteristics

	Sugammadex (n = 333)	Neostigmine/Glycopyrrolate (n = 307)	P-Value
Age, years (mean, SD)	55.79 ± 16.41	55.49 ± 16.63	0.986
Male (n, %)	138 (41.44)	146 (47.56)	0.120
Weight, kg (mean, SD)	87.38 ± 24.88	87.30 ± 22.91	0.667
Time, min (median, IQR)
Procedure duration	90.00 (49.00–143.00)	102.00 (65.00–177.00)	0.001
OR duration	144.00 (97.00–205.00)	156.00 (117.00–235.00)	0.002
Anesthesia duration	150.00 (100.00–213.00)	164.00 (123.00–240.00)	0.002
Neuromuscular blocker (n, %)
Rocuronium	330 (99.10)	297 (96.74)	0.048
Vecuronium	3 (0.90)	5 (1.63)	0.490
Succinylcholine	0 (0.00)	5 (1.63)	0.025
Reversal agent dose
Sugammadex (mg/kg)	2.90	0	-
Neostigmine (mg/kg)	0	0.05	-
Glycopyrrolate (mg)	0	0.57	-
TOF monitoring post-reversal agent administration (n, %)
TOF count of 0	2 (0.60)	1 (0.33)	1.000
TOF count of 1	1 (0.30)	2 (0.65)	0.610
TOF count of 2	5 (1.50)	2 (0.65)	0.453
TOF count of 3	4 (1.20)	13 (4.23)	0.024
TOF count of 4	321 (96.40)	289 (94.14)	0.177

Notes: Data are displayed as either mean (standard deviation), median (interquartile range), number, or percentage. The average total dose of sugammadex and neostigmine/glycopyrrolate are represented. Time is formatted as minutes.

Abbreviations: SD, standard deviation; n, number; %, percent; kg, kilograms; IQR, interquartile range; OR, operating room; mg, milligrams; TOF, train-of-four.

Table 2 Research Outcomes

	Sugammadex (n = 333)	Neostigmine/Glycopyrrolate (n = 307)	P-Value
Primary endpoint (min), median (IQR)
Reversal agent administration to OR exit	23.00 (18.00–31.00)	27.00 (21.00–35.00)	<0.001
Secondary endpoints (min), median (IQR)
Reversal agent administration to extubation	16.00 (11.00–23.00)	22.08 (15.05–30.63)	<0.001
Procedure end to extubation	6.00 (4.00–9.00)	6.80 (3.68–10.45)	0.126
Procedure end to OR exit	13.00 (10.00–17.00)	12.00 (8.00–16.00)	0.001
Reversal agent administration to PACU entry	25.00 (20.00–32.00)	28.00 (22.00–36.00)	<0.001
Reversal agent administration to anesthesia end	29.00 (24.00–38.00)	33.00 (27.00–42.00)	<0.001
PACU admission to PACU exit	63.00 (46.00–94.00)	69.00 (45.00–93.00)	0.624
Exploratory endpoints
Post-surgical length of stay, days	0.95	1.09	<0.001
Reversal agent administration prior to procedure end (n, %)	304 (91.29)	294 (95.77)	0.022
Reversal agent administration following procedure end (n, %)	29 (8.71)	13 (4.23)	0.022
Adverse effects (n, %)
Pneumonia	0 (0.00)	1 (0.33)	0.480
Re-intubation	0 (0.00)	0 (0.00)	-
Hypersensitivity	0 (0.00)	0 (0.00)	-
SPO2 saturation less than 90%	21 (6.31)	16 (5.21)	0.553
PONV	56 (16.82)	6 (1.95)	<0.001

Notes: Data are displayed as either median (interquartile range), number, or percentage. Time is formatted as minutes.

Abbreviations: IQR, interquartile range; OR, operating room; PACU, postanesthesia care unit; n, number; %, percent; PONV, postoperative nausea and vomiting; SPO₂, peripheral capillary oxygen saturation.

Table 3 Houston Methodist Hospital Procedure Service Line Distribution

Procedure Service Line (n, %)	Sugammadex (n = 333)	Neostigmine/Glycopyrrolate (n = 307)	P-Value
General  Laparoscopic cholecystectomy	96 (28.83) 14 (4.20)	85 (27.69) 16 (5.21)	0.749 0.547
Ear, nose, and throat	81 (24.32)	15 (4.89)	<0.001
Orthopedics	55 (16.52)	85 (27.69)	0.001
Urology	28 (8.41)	51 (16.61)	0.002
Obstetrics and gynecology	10 (3.00)	16 (5.21)	0.157
Colon and rectal surgery	27 (8.11)	20 (6.51)	0.440
Plastics	11 (3.30)	16 (5.21)	0.230
Oral surgery	3 (0.90)	11 (3.58)	0.028
Ophthalmology	17 (5.11)	3 (0.98)	0.003
Thoracic	3 (0.90)	1 (0.33)	0.625
Cardiovascular	1 (0.30)	1 (0.33)	1.000
Pain management	1 (0.30)	2 (0.65)	0.610
Vascular	–	1 (0.33)	–

Notes: Data are displayed as either number or percentage. Laparoscopic cholecystectomy represented the primary surgical procedure with commonality between sugammadex and neostigmine/glycopyrrolate cohorts.

Abbreviations: n, number; %, percent.

Table 4 Houston Methodist Hospital Procedure Service Line by Primary Endpoint

	Sugammadex (n = 333)	Neostigmine/Glycopyrrolate (n = 307)	P-Value
Primary endpoint (min), median (IQR)
General   Laparoscopic cholecystectomy	24.00 (20.50–29.50) 22.50 (20.00–30.00)	23.00 (19.00–29.00) 23.00 (20.50–28.50)	0.325 0.708
Ear, nose, and throat	22.00 (16.00–33.00)	22.00 (16.00–24.00)	0.698
Orthopedics	28.00 (19.00–37.00)	31.50 (22.50–39.00)	0.042
Urology	19.50 (15.00–23.00)	29.00 (24.00–35.00)	<0.001
Obstetrics and gynecology	26.50 (22.00–44.00)	30.00 (18.50–35.50)	0.673
Colon and rectal surgery	23.00 (19.00–27.00)	24.00 (21.50–26.50)	0.533
Plastics	34.00 (22.00–47.00)	30.50 (23.00–46.50)	0.693
Oral surgery	22.00 (13.00–196.00)	24.00 (18.00–36.00)	0.815
Ophthalmology	19.00 (16.00–21.00)	17.00 (15.00–27.00)	0.874
Thoracic	31.00 (13.00–33.00)	34.00 (34.00–34.00)	0.180
Cardiovascular	16.00 (16.00–16.00)	83.00 (83.00–83.00)	0.317
Pain management	10.00 (10.00–10.00)	24.00 (23.00–25.00)	0.221
Vascular	-	35.00 (35.00–35.00)	-

Notes: Data are displayed as either median (interquartile range) or number. Laparoscopic cholecystectomy represented the primary surgical procedure with commonality between sugammadex and neostigmine/glycopyrrolate cohorts. Time is formatted as minutes.

Abbreviations: n, number; IQR, interquartile range.

Table 5 Average Medication Wholesale Price Information with Average Dose Cost

Medication	Average Wholesale Unit Price	Average Dose Cost
Sugammadex 500 mg/5 mL single-dose 5-mL vial	$219.24	$223.85
Sugammadex 200 mg/2 mL single-dose 2-mL vial	$119.69	$186.18
Neostigmine 10 mg/10 mL multiple-dose 10-mL vial	$22.03	$22.03
Neostigmine 5 mg/10 mL multiple-dose 10-mL vial	$20.81	$20.81
Glycopyrrolate 0.2 mg/1 mL single-dose 1-mL vial	$8.40	$24.84
Glycopyrrolate 0.4 mg/2 mL single-dose 2-mL vial	$16.68	$29.29

Note: The average dose cost per medication was calculated from the average cost of patient-specific medication doses.

Abbreviations: mg, milligram; mL, milliliter; $, United States dollar.