Effect of Sugammadex on Post-operative Urinary Retention After Bariatric Surgery.

Background: The incidence of post operative urinary retention (POUR) after bariatric surgery has been described to be anywhere between 5 and 8%. This incidence is thought to be related in part to medications for neuromuscular blockade (NMBA) reversal. The purpose of this study was to determine the difference between sugammadex and neostigmine with an antimuscarinic agent on reducing POUR in bariatric patients.

Methods: Single center, retrospective, cohort, chart review study performed at a single academic institution. Patients who underwent primary laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LGBP) and were administered NMBAs, with subsequent reversal with either neostigmine with an antimuscarinic agent (N = 121) or with sugammadex (N = 107), formed the cohort. POUR was defined as the inability to void post-operatively within 6 h, requiring eventual urinary straight catheterization or placement of an indwelling urinary catheter at any time before discharge.

Results: A total of 7.9% developed POUR following bariatric surgery. The incidence of POUR was significantly lower in the sugammadex group when compared to the neostigmine group (1.9% vs 13.2%, p < 0.001). The length of stay was also significantly shorter in the sugammadex group when compared to the neostigmine group (1.7 (SD 0.7) vs 1.9 days (SD 0.6), p < 0.001). There was no significant difference in the rate of readmission (4.1% vs 3.7%, p = 0.561) or emergency department visits (10.7% vs 10.3%, p = 0.564). Multivariable regression demonstrated that sugammadex use was independently associated with a lower likelihood of developing POUR after surgery (OR 0.127 (95% CI 0.028-0.586), p = 0.008).

Conclusions: The rate of POUR after bariatric surgery was significantly lower in the patients undergoing NMBA reversal with sugammadex when compared to neostigmine. This group also experienced a shorter length of stay.