TY - JOUR
T1 - Sugammadex and urinary retention after hysterectomy
T2 - A propensity-matched cohort study
AU - De Lima Laporta Miranda, Mariana L.
AU - Ochs Kinney, Michelle A.
AU - Bakkum-Gamez, Jamie N.
AU - Schroeder, Darrell R.
AU - Sprung, Juraj
AU - Weingarten, Toby N.
N1 - Publisher Copyright:
© 2023 De Lima Laporta Miranda et al.
PY - 2024
Y1 - 2024
N2 - Postoperative urinary retention (POUR) is a well-known complication after gynecologic surgery. Our objective was to investigate whether the choice of a 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 the 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 1974 patients, of whom 1586 (80.3%) received neostigmine-glycopyrrolate and 388 (19.7%) received sugammadex for reversal of neuromuscular blockade. The frequency of POUR was 24.8% (393/1586) 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 (OR) 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 (OR 1.86, 95% CI 1.07–3.22, P = 0.03). The use of sugammadex to reverse aminosteroid neuromuscular blocking agents is associated with the decreased risk of POUR after hysterectomy. A potential mechanism is the omission of glycopyrrolate, which is coadministered with neostigmine to mitigate unwanted cholinergic effects.
AB - Postoperative urinary retention (POUR) is a well-known complication after gynecologic surgery. Our objective was to investigate whether the choice of a 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 the 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 1974 patients, of whom 1586 (80.3%) received neostigmine-glycopyrrolate and 388 (19.7%) received sugammadex for reversal of neuromuscular blockade. The frequency of POUR was 24.8% (393/1586) 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 (OR) 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 (OR 1.86, 95% CI 1.07–3.22, P = 0.03). The use of sugammadex to reverse aminosteroid neuromuscular blocking agents is associated with the decreased risk of POUR after hysterectomy. A potential mechanism is the omission of glycopyrrolate, which is coadministered with neostigmine to mitigate unwanted cholinergic effects.
KW - General anesthesia
KW - glycopyrrolate
KW - neuromuscular blocking drugs
KW - sugammadex
KW - urinary retention
UR - http://www.scopus.com/inward/record.url?scp=85187421511&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85187421511&partnerID=8YFLogxK
U2 - 10.17305/bb.2023.9569
DO - 10.17305/bb.2023.9569
M3 - Article
C2 - 37715536
AN - SCOPUS:85187421511
SN - 2831-0896
VL - 24
SP - 395
EP - 400
JO - Biomolecules and Biomedicine
JF - Biomolecules and Biomedicine
IS - 2
ER -