Anisse N. Chaker, MD: No financial relationships to disclose
Introduction: Post-operative urinary retention (POUR) is a well described adverse event in elective lumbar spine surgery. Several post-operative measures have been studied to lower the incidence of POUR, though there is a paucity of literature investigating the effect of standard pharmacologic agents used during surgery on POUR. Specifically, the use of Sugammadex is of interest in reducing POUR given its non-muscarinic mechanism. 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. 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.
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. Multivariate logistic regression models controlling for various patient and operative characteristics were utilized to compare outcomes between patients who received Sugammadex or Neostigmine/Glycopyrrolate. The primary outcome was urinary retention, with secondary outcomes including ileus, length of stay (LOS), and non-home discharge.
Results: 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 non-home discharge. Of note, in those patients who experienced urinary retention, there was a higher rate of non-home 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.
Conclusion : The utilization of Sugammadex as a paralytic reversal agent was associated with decreased POUR in elective lumbar spine surgery. This may ultimately avoid further patient complications, decrease hospital costs, and increase patient satisfaction.