53. Sugammedex and postoperative urinary retention in lumbar spine surgery: a Michigan Spine Surgery Improvement Collaborative (MSSIC) study

Document Type

Conference Proceeding

Publication Date

11-11-2025

Publication Title

Spine J

Abstract

BACKGROUND CONTEXT: Postoperative urinary retention (POUR) is a well described adverse event in elective lumbar spine surgery. Though several postoperative measures have been identified to lower the incidence of POUR, investigating the effect of standard pharmacologic agents used during surgery on POUR is needed. Specifically, given the nonmuscarinic mechanism of the paralytic reversal agent, Sugammadex, it is of interest in reducing POUR. Other standard reversal agents include cholinesterase inhibitors such as Neostigmine, which is paired with an anticholinergic agent (Glycopyrrolate) that carries a known risk of urinary retention. PURPOSE: We aim to determine the effect of utilizing Sugammadex versus Neostigmine/Glycopyrrolate as a paralytic reversal agent on POUR in elective lumbar spine surgery patients. STUDY DESIGN/SETTING: N/A. PATIENT SAMPLE: N/A. OUTCOME MEASURES: N/A. METHODS: The Michigan Spine Surgery Improvement Collaborative (MSSIC) database was queried for patients who underwent elective lumbar spine surgery from January 2019 to January 2023 at a single institution. Patients were grouped base on those who received Sugammadex or Neostigmine/Glycopyrrolate. Multivariate logistic regression models controlling for various patient and operative characteristics were utilized to compare outcomes between patients who received while controlling for confounders. The primary outcome was urinary retention, with secondary outcomes including ileus, length of stay (LOS), and non-home discharge. RESULTS: A total of 1,898 patients were included in the analysis. Patients who received Neostigmine/Glycopyrrolate were more likely to experience POUR, with a rate of 5.8% for the Neostigmine/Glycopyrrolate group versus 3.3% for the Sugammadex group (OR=1.74; CI: 1.10-2.76, p=0.019). There was no difference in odds of ileus, LOS ≥ 3 days, or nonhome discharge. Of note, in those patients who experienced urinary retention, there was a higher rate of nonhome discharge (22% versus 5.2%, p<0.001) and LOS ≥ 3 days (60% versus 26%, p<0.001) compared to patients who did not have POUR. CONCLUSIONS: Utilization of Sugammadex as a paralytic reversal agentwas associated with decreased POUR in elective lumbar spine surgery. Give the association of POUR with non-home discharge and increased length of stay, utilization of Sugammadex may ultimately avoid further patient complications while decreasing hospital and patient costs. FDA Device/Drug Status: Sugammadex (Approved for this indication).

Volume

25

Issue

11

First Page

S29

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