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

I Tsouknidas; S Perez; E Kunkel; C Tiko-Okoye; M E Buckley; J Y Gefen

doi:10.1007/s10029-024-03038-4

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

Hernia. 2024 Apr 29. doi: 10.1007/s10029-024-03038-4. Online ahead of print.

Authors

I Tsouknidas¹, S Perez², E Kunkel³, C Tiko-Okoye⁴, M E Buckley⁵, J Y Gefen²

Affiliations

¹ Department of Surgery, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA. tsouknidasioannis@gmail.com.
² Department of Surgery, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA.
³ Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego (UCSD), San Diego, CA, USA.
⁴ Department of Acute Care, Trauma & Critical Care Surgery, Duke University Hospital, Durham, NC, USA.
⁵ Main Line Health Center for Population Health Research, Lankenau Institute for Medical Research, Wynnewood, PA, USA.

PMID: 38683482
DOI: 10.1007/s10029-024-03038-4

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.

Keywords: Inguinal hernia repair; Minimally invasive surgery; Neostigmine/glycopyrrolate; Post-operative urinary retention; Sugammadex.