Neuromuscular Blockade Reversal with Sugammadex Reduces Cardiac Complications and OR Time for Prone Lumbar Spinal Fusion Compared to Neostigmine.

Study design: Retrospective cohort study.

Objective: To evaluate inpatient complication profiles of patients receiving neuromuscular blockade reversal via sugammadex versus neostigmine/glycopyrrolate.

Summary of background data: Sugammadex is a neuromuscular blockade reversal agent that binds non-depolarizing muscle relaxants. This is a different mechanism from traditional reversal agents such as the combination drug neostigmine (acetylcholinesterase inhibitor)/glycopyrrolate (antimuscarinic agent). Sugammadex has theoretical advantages related to more predictable and rapid reversal, and decreased autonomic side effects. While these agents have been compared in non-spine literature, there is minimal research examining their impact during prone lumbar fusion.

Methods: All adult patients who underwent a primary one- or two-level posterior lumbar fusion (L4-S1) at a single academic center (2018-2021) were retrospectively identified. Neuromuscular blockade reversal agents (sugammadex or NG), demographics, surgical characteristics, and surgical outcomes were collected through a Structured Query Language search and confirmed by chart review. Bivariate analysis and multivariate linear regression were performed. Alpha was set at P<0.05.

Results: In the NG group, more patients had ≥1 inpatient complication (31.2% vs. 19.9%, P=0.012) and cardiac complication (19.1% vs. 11.3%, P=0.040). NG had higher total (0.40±0.66 vs. 0.28±0.62, P=0.046) and cardiac (0.23±0.50 vs. 0.13±0.37, P=0.009) complication rates per person. Operative time was longer amongst patients reversed with NG (182±55.9 vs. 174±55.9, P=0.039). Multivariable linear regression for inpatient complications demonstrated that sugammadex (estimate=-0.124, P=0.045) was negatively predictive of inpatient complications, while Elixhauser (estimate=0.073, P<0.001) was positively predictive.

Conclusion: The current results demonstrate that sugammadex may create less risk for cardiac complications, and is likely associated with more rapid reversal and decreased OR time during prone lumbar fusion. However, additional research is needed to further validate these findings, especially amongst patients with cardiac comorbidities.