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Use of sugammadex in prevention of post-operative urinary retention in minimally invasive hernia surgery

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Abstract

Purpose

Post-operative urinary retention (POUR) is a known complication of hernia surgery. Minimally invasive inguinal hernia repair (IHR) is typically done under general anesthesia with neuromuscular blockade (NMB), which is commonly reversed with an anticholinesterase inhibitor paired with an anticholinergic agent. Sugammadex is a unique NMB reversal agent that does not have to be paired with an anticholinergic. We sought to explore the role of sugammadex in reducing the rate of POUR following these procedures.

Methods

Data were collected retrospectively at a single institution between February 2016 and October 2019. We identified and studied patients who underwent minimally invasive IHR and received either sugammadex or neostigmine/glycopyrrolate for NMB reversal. The primary endpoint was POUR requiring bladder catheterization. Secondary endpoints included post-operative and 30-day readmissions.

Results

274 patients were included in this study (143 received neostigmine and glycopyrrolate, 131 sugammadex). The sugammadex patients were on average 5 years older than the neostigmine/ glycopyrrolate patients (63.2 vs 58.2, p = 0.003), and received less median intravenous fluids (IVF) (900 ml vs 1000 ml; p = 0.015). There was a significant difference in the rate of POUR between the sugammadex and neostigmine/glycopyrrolate patients (0.0% vs 8.4%, p ≤ 0.001). The difference remained significant after controlling for age and IVF. The odds of POUR for those who received neostigmine/glycopyrrolate were 25 × higher than the odds of those who received sugammadex.

Conclusion

The results of this study reflect the protective role of sugammadex against POUR in minimally invasive IHR cases.

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Data availability

Not applicable.

Abbreviations

IHR:

Inguinal hernia repair

POUR:

Post Operative Urinary Retention

NMB:

Neuromuscular blockade

BMI:

Body Mass Index

ASA:

American Society of Anesthesia class

ESRD:

End-stage renal disease

BPH:

Benign prostatic hyperplasia

IVF:

Intravenous fluids

EBL:

Estimated blood loss

NGP:

Neostigmine/Glycopyrrolate

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Funding

This study received no funding.

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Authors and Affiliations

  1. Department of Surgery, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA

    I. Tsouknidas, S. Perez & J. Y. Gefen

  2. Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego (UCSD), San Diego, CA, USA

    E. Kunkel

  3. Department of Acute Care, Trauma & Critical Care Surgery, Duke University Hospital, Durham, NC, USA

    C. Tiko-Okoye

  4. Main Line Health Center for Population Health Research, Lankenau Institute for Medical Research, Wynnewood, PA, USA

    M. E. Buckley

Authors
  1. I. Tsouknidas
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  2. S. Perez
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  3. E. Kunkel
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  4. C. Tiko-Okoye
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  5. M. E. Buckley
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  6. J. Y. Gefen
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Corresponding author

Correspondence to I. Tsouknidas.

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Conflict of interest

All authors (Ioannis Tsouknidas, Stephanie Perez, Emily Kunkel, Chidinma Tiko-Okoye, Meghan E Buckley, and Jonathan Y Gefen) declare that they have no conflict of interest.

Ethical approval

The study was approved by the IRB of Main Line Health as Exempt Research with Waiver of HIPAA Authorization.

Human and animal rights

No animal experiments were performed in this study. All procedures performed in studies involving human participants were in accordance with the ethical standards of our institutional research committee.

Informed consent

This retrospective study involved analysis of de-indified data, so informed consent was waived by the IRB of Main Line Health.

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Tsouknidas, I., Perez, S., Kunkel, E. et al. Use of sugammadex in prevention of post-operative urinary retention in minimally invasive hernia surgery. Hernia (2024). https://doi.org/10.1007/s10029-024-03038-4

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