Sugammadex and urinary retention after hysterectomy: A propensity-matched cohort study

Authors

  • Mariana L. De Lima Laporta Miranda Department of Anesthesiology and Perioperative Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
  • Michelle A. Ochs Kinney Department of Anesthesiology and Perioperative Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
  • Jamie N. Bakkum-Gamez Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
  • Darrell R. Schroeder Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
  • Juraj Sprung Department of Anesthesiology and Perioperative Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
  • Toby N. Weingarten Department of Anesthesiology and Perioperative Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA

DOI:

https://doi.org/10.17305/bb.2023.9569

Keywords:

General anesthesia, glycopyrrolate, neuromuscular blocking drugs, sugammadex, urinary retention

Abstract

Postoperative urinary retention (POUR) is a well-known complication after gynecologic surgery. Our objective was to investigate whether the choice of pharmacologic agent for reversing neuromuscular blockade at the end of a hysterectomy is a risk factor for POUR. Among adult patients undergoing hysterectomy with general anesthesia from 2012 to 2017, those who received aminosteroid nondepolarizing neuromuscular agents followed by pharmacologic reversal were identified, and electronic health records were reviewed. The cohort was dichotomized into two groups by reversal agent: 1) sugammadex and 2) neostigmine with glycopyrrolate. The primary outcome, POUR, was defined as unplanned postoperative bladder recatheterization. A propensity-adjusted analysis was performed to investigate the association between POUR and reversal agent by using inverse probability of treatment weighting to adjust for potential confounders. We identified 1,974 patients, of whom 1,586 (80.3%) received neostigmine-glycopyrrolate and 388 (19.7%) received sugammadex for reversal of neuromuscular blockade. The frequency of POUR was 24.8% (393/1,586) after reversal with neostigmine-glycopyrrolate and 18.3% (71/388) with sugammadex. Results from the propensity-adjusted analysis showed that sugammadex was associated with a lower POUR risk than neostigmine-glycopyrrolate (odds ratio 0.53, 95% confidence interval [CI] 0.37 - 0.76, P < 0.001). A post hoc analysis of sugammadex recipients who received glycopyrrolate for another indication showed a higher POUR risk than among those who did not receive glycopyrrolate (odds ratio 1.86, 95% CI 1.07 - 3.22, P = 0.03). Use of sugammadex to reverse aminosteroid neuromuscular blocking agents is associated with decreased risk of POUR after hysterectomy. A potential mechanism is the omission of glycopyrrolate, which is coadministered with neostigmine to mitigate unwanted cholinergic effects.

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Author Biography

  • Toby N. Weingarten, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA

    Department of Anesthesiology and Perioperative Medicine

    Professor of Anesthesiology

Sugammadex and urinary retention after hysterectomy: A propensity-matched cohort study

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Published

11-03-2024

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Section

Translational and Clinical Research

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How to Cite

1.
Sugammadex and urinary retention after hysterectomy: A propensity-matched cohort study. Biomol Biomed [Internet]. 2024 Mar. 11 [cited 2024 Apr. 18];24(2):395–400. Available from: https://bjbms.org/ojs/index.php/bjbms/article/view/9569