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The use of sugammadex for bariatric surgery: analysis of recovery time from neuromuscular blockade and possible economic impact

Authors De Robertis E, Zito Marinosci G, Marco Romano G, Piazza O, Iannuzzi M, Cirillo F, De Simone S, Servillo G

Received 6 April 2016

Accepted for publication 10 May 2016

Published 29 June 2016 Volume 2016:8 Pages 317—322

DOI https://doi.org/10.2147/CEOR.S109951

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 3

Editor who approved publication: Professor Giorgio Lorenzo Colombo

Edoardo De Robertis,1 Geremia Zito Marinosci,1 Giovanni Marco Romano,1 Ornella Piazza,2 Michele Iannuzzi,1 Fabrizio Cirillo,1 Stefania De Simone,3 Giuseppe Servillo,1

1Department of Neurosciences, Reproductive and Odontostomatologic Sciences, University Federico II, Naples, 2Department of Medicine and Surgery, University of Salerno, Salerno, 3Institute for Research on Innovation and Services for Development, National Research Council, Naples, Italy

Background: Neuromuscular block (NMB) monitoring and use of reversal agents accelerate the recovery time and improve the workflow in the operating room. We aimed to compare recovery times after sugammadex or neostigmine administration, and estimate the time spent in operating theater and the possible economic impact of a faster recovery, in morbidly obese patients undergoing bariatric surgery.
Methods: We conducted a retrospective study that analyzed data from records of morbidly obese patients (body mass index >40 kg/m2) undergoing elective laparoscopic bariatric surgery in which sugammadex or neostigmine were used to reverse NMB. Patients were divided in two groups: group 1 (sugammadex group [SUG]) received rocuronium and sugammadex for reversal and group 2 (neostigmine group [NEO]) received either rocuronium or cisatracurium and neostigmine. Data are presented as mean (standard deviation).
Results: Compared with NEO, SUG group showed shorter times to achieve train-of-four ratio of 0.9 (P<0.05) and an Aldrete score of 10 (P<0.05), a higher cost (€146.7 vs €3.6 [P<0.05]), plus a remarkable less duration of operating theater occupancy (P<0.05). Sugammadex cost accounted for 2.58% of the total cost per surgery, while neostigmine cost accounted for 0.06%. Total time saved in SUG group was 19.4 hours, which could be used to perform 12 extra laparoscopic sleeve gastrectomies.
Conclusion: Reversal from NMB was significantly faster with sugammadex than with neostigmine. Although sugammadex was substantially more expensive, duration of operating theater occupancy was reduced with potentially workflow increase or personnel reduced cost.

Keywords: PORC, pharmacoeconomics, laparoscopic surgery, reversal agents

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