Analysis of Sugammadex Use in a Variety of Patient Populations Using Multicenter Perioperative Outcomes Group Data
Objectives: Sugammadex is a medication indicated for reversal of paralysis caused by the administration of aminosteroid non-depolarizing neuromuscular blocking agents. It first became available at Beaumont Hospital in June 2017. This retrospective study uses data from the Multicenter Perioperative Outcomes Group (MPOG) to analyze which patient populations are more likely to receive sugammadex. MPOG is an association of 48 hospitals that uses the electronic healthcare record in an effort to improve patient care. Data from this perioperative anesthesia registry includes patient comorbidities, surgical procedure, medication administration, intervention, and postoperative outcome. This study specifically assesses the use of sugammadex as a first line or rescue medication in a variety of patient populations.
Following institutional MPOG IRB approval, MPOG’s DataDirect application was utilized to filter patients by healthcare institution, date of service (beginning June 2017), diagnosis, ASA status, admission status, or procedure. These cases were then filtered by the administration of neostigmine, sugammadex as first line reversal, or neostigmine and sugammadex (rescue reversal). Using these numbers, the total number of patients who received reversal was calculated. The percent of cases that received sugammadex as first line reversal and as rescue reversal following neostigmine was then calculated for both the entire sample population as well as those with a variety of different comorbidities.
Using MPOG’s DataDirect application, 27,636 patients 18 years or older were identified as having received either neostigmine or sugammadex) between June 1, 2017 and March 27, 2019 at Beaumont Health’s Royal Oak campus. Of these patients, 3% received sugammadex as a first line reversal agent and 1.3% received sugammadex as a rescue agent. These numbers were used as a baseline against which subsequent patient populations were compared. Patients were then filtered by a variety of medical conditions or procedures and the percent that received sugammadex as first line reversal and as rescue reversal was calculated for each subset of patients. Results showed several patient conditions which were more likely to receive sugammadex as either first line reversal or rescue reversal (table 1).
This data shows that sugammadex is at least twice as likely to be used as a rescue reversal agent in patients with COPD, muscular dystrophy, malnutrition, and ASA 4 patients. When these variables are combined, patients are even more likely to receive sugammadex. It may be beneficial to begin using sugammadex as first line reversal in these particular patients in an effort to reduce costs at our institution. However, it is important to note some limitations of MPOG and this study. First, if the number of cases that results is less than 10, MPOG does not report an exact number. For example, for two patient variables (short case duration and underweight patients) the number of patients that received sugammadex as rescue reversal resulted as “
McDavid M, Price MD, Soto RG. Analysis of sugammadex use in a variety of patient populations using multicenter perioperatives outcomes group data. Abstract presented at: Anesthesiology 2019. American Society of Anesthesiology, Orlando, FL. 2019 October 19-23.