Effect of Neuromuscular Blockade Reversal on Post-operative Urinary Retention Following Inguinal Herniorrhaphy

Document Type

Conference Proceeding

Publication Date

6-7-2023

Publication Title

Surg Endosc

Abstract

Introduction: Within the United States, reversal of nondepolarizing neuromuscular blockade is routinely accomplished by anticholinesterases such as neostigmine combined with glycopyrrolate or edrophonium combined with atropine. Sugammadex, a selective antagonist for rocuronium, is commonly utilized due to rapid onset of action and decreased side effect profile. Sugammadex was previously associated with reduced rates of post operative urinary retention (POUR) compared to anticholinesterases. This study aims to define the risk of POUR following inguinal herniorrhaphy in those that received sugammadex compared to anticholinesterases in a single tertiary referral center. Methods: All adults undergoing inguinal herniorrhaphy from 1/1/ 2019 to 7/1/2022 with at least 30 days of follow up were identified. Inclusion criteria include those who received aminosteroid non-depolarizing muscle relaxants rocuronium or edrophonium and were reversed with an anticholinesterase or sugammadex. Patients who did not receive a neuromuscular blocking agent were excluded. The 30-day incidence of new onset POUR was identified through chart review. 1 to 2 propensity score matched models were fitted to evaluate the treatment of effect of sugammadex vs. anticholinesterase on POUR adjusting for patient comorbidities, ASA class, wound class, operative laterality, urgency of case, and open vs. minimally invasive repair. Results: 3345 patients were included in this study with 1101 receiving sugammadex and 2244 receiving anticholinesterase for neuromuscular blockade reversal. The 30-day rate of new POUR was 2.8%, 1.4% in the sugammadex and 4.4% in the anticholinesterase groups respectively. 61% of the cohort received elective herniorrhaphy, 73.6% were unilateral repairs, 0.75% were repeat herniorrhaphy on the same side, 3.2% required inpatient stay post-operatively with average length of stay of 1.5 days [IQR: 1-2]. After propensity score matching, patients receiving sugammadex had significantly lower risk of POUR compared to anticholinesterase overall (OR: 0.340, P<0.001, 95% C.I. = 0.198-0.585), in open cases (OR: 0.296, P = 0.013, 95% C.I. = 0.113-0.775), minimally invasive cases (OR: 0.36, P = 0.002, 95% C.I. = 0.188-0.693), unilateral repairs (OR: 0.371, P = 0.001, 95% C.I. = 0.203-0.681), bilateral repairs (OR: 0.25, P = 0.025, 95% C.I. = 0.074-0.838), elective cases (OR: 0.329, P<0.001, 95% C.I. = 0.185-0.584), and clean cases (OR: 0.312, P<0.001, 95% C.I. = 0.176-0.553). Conclusions: The incidence of 30-day new onset post-operative urinary retention in our cohort was 2.8%. Sugammadex for neuromuscular blockade was associated with significantly lower risk of 30-day new onset POUR compared to anticholinesterase overall and when stratifying by operative modality, laterality, and wound class. (Figure Presented).

Volume

37

First Page

S307

Last Page

S308

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