OBJECTIVES: : Sugammadex is a novel neuromuscular blockade (NB) reversal agent that has demonstrated a faster and more predictable reversal than acetylcholinesterase inhibitors such as neostigmine. Despite published literature on cost/benefit utilization, financial concerns of broad implementations of sugammadex usage have been noted. To understand potential demographic differences between neostigmine and sugammadex use, we examined baseline characteristics of patients who received either neostigmine or sugammadex during common abdominal surgeries requiring intra- or perioperative NB.

METHODS: Using a large, de-identified US electronic health record database (Cerner Real-World Data), we extracted data from all adult patients (≥18 years) who underwent an inguinal hernia surgery, exploratory laparotomy, cholecystectomy, or appendectomy between January 2016 and May 2021, using ICD-10-PCS and Current Procedural Terminology codes, and included those who received intra/perioperative rocuronium- or vecuronium-induced NB. Patient characteristics and Charlson Comorbidity Index (CCI) were compared across both NB reversal agents used intraoperatively.

RESULTS: Out of 74,088 patients who underwent surgeries, 30,716 (41%) received sugammadex. Compared to neostigmine, sugammadex administration occurred more frequently in men than women (41.8% vs. 40.5%), obese patients than underweight (43.4% vs. 41.5%), and patients aged 60+ than those aged 18-59 (43.4% vs. 40.3%). Patients with CCI of 4+ received sugammadex more than patients with scores of 0 (49.3% vs. 41.1%). Hispanic/Latinx patients were the least likely to have received sugammadex out of all ethnic groups (29.3% vs. 41.5%). Furthermore, Medicare and Medicaid patients had the highest rate of receiving sugammadex (42.8% and 43.3% respectively), followed by self-paying (42.0%) and commercially insured patients (39.7%).

CONCLUSIONS: This study indicates that certain patient demographics may influence healthcare providers’ decision to administer sugammadex over acetylcholinesterase inhibitors. Future studies are required to understand whether other surgical procedures which require NB reversal show similar trends and/or variances in sugammadex administration, to highlight any disparities in access to care.