Analysis of characteristics of patients whose sugammadex claims were denied by the Auto Insurance Claims Review Department of Korean Health Insurance Review & Assessment Service: a retrospective single-center review.

Abstract

Background: Recently, there have been many cases where sugammadex used in traffic accident patients has been deducted from auto insurance claims. This study aims to investigate the characteristics of sugammadex deductions through retrospective analysis.

Methods: We included patients who underwent general anesthesia after traffic accidents at our institution between January 2019 and December 2023. Data for patients for whom sugammadex payments were deducted from the Auto Insurance Claims Review Department of the Korean Health Insurance Review and Assessment Service were obtained from the hospital's insurance department, and electronic medical records were analyzed. The characteristics of neuromuscular blockade (NMB) and its reversal, including administration time and dosage of neuromuscular blockading agent (NMBA) and reversal agent, intraoperative neuromuscular transmission (NMT) monitoring results, and reasons for sugammadex use, were assessed and analyzed.

Results: A total of 251 patients deducted sugammadex payments during the study period. The deduction rate significantly decreased from 88-100% in previous years to 43.4% in 2023. Sugammadex was used to reverse deep NMB (55.1%) and in high-risk patients (23.1%). Sugammadex was mostly used to reverse deep NMB (55.1%) and in high-risk patients (23.1%). NMT monitoring was documented in 81.3% of cases, with 38.9% showing deep NMB and 33.3% showing moderate NMB. Despite improved NMT documentation after 2021, sugammadex payment deductions persisted.

Conclusions: Sugammadex payment deductions occur despite clinical necessity, particularly in deep and moderate NMB cases. Thorough documentation may help reduce these deductions. Collaboration between healthcare providers and policymakers is required to use reversal agents guided by clinical evidence.