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Impact of Sugammadex Versus Neostigmine/Glycopyrrolate on Perioperative Efficiency

Authors Deyhim N, Beck A, Balk J, Liebl MG

Received 29 June 2019

Accepted for publication 26 September 2019

Published 31 January 2020 Volume 2020:12 Pages 69—79


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Dean Smith

Niaz Deyhim,1,2 Amanda Beck,1 Jonathan Balk,1 Michael G Liebl3

1Department of Pharmacy Services, Houston Methodist Hospital, Houston, TX, USA; 2Department of Pharmacy Practice, University of Houston College of Pharmacy, Houston, TX, USA; 3Department of Pharmacy Services, Houston Methodist System, Houston, TX, USA

Correspondence: Amanda Beck
Department of Pharmacy Services, Houston Methodist Hospital, 6565 Fannin Street, DB1-09, Houston, TX 77030, USA
Tel +1 713 363 7342 Fax +1 713 4411225

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

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