Sugammadex for reversal of neuromuscular blockade: a retrospective analysis of clinical outcomes and cost-effectiveness in a single center

Michele Carron, Fabio Baratto, Francesco Zarantonello, Carlo Ori Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Padova, Italy Objective: The aim of the study is to evaluate the clinical and economic impact of introducing a rocuronium–neostigmine–...

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Hoofdauteurs: Carron M (Auteur), Baratto F (Auteur), Zarantonello F (Auteur), Ori C (Auteur)
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Gepubliceerd in: Dove Medical Press, 2016-02-01T00:00:00Z.
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Samenvatting:Michele Carron, Fabio Baratto, Francesco Zarantonello, Carlo Ori Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Padova, Italy Objective: The aim of the study is to evaluate the clinical and economic impact of introducing a rocuronium&ndash;neostigmine&ndash;sugammadex strategy into a cisatracurium&ndash;neostigmine regimen for neuromuscular block (NMB) management. Methods: We conducted a retrospective analysis of clinical outcomes and cost-effectiveness in five operating rooms at University Hospital of Padova. A clinical outcome evaluation after sugammadex administration as first-choice reversal drug in selected patients (rocuronium&ndash;sugammadex) and as rescue therapy after neostigmine reversal (rocuronium&ndash;neostigmine&ndash;sugammadex) compared to control was performed. A cost-analysis of NMB management accompanying the introduction of a rocuronium&ndash;neostigmine&ndash;sugammadex strategy into a cisatracurium&ndash;neostigmine regimen was carried out. To such purpose, two periods were compared: 2011&ndash;2012, without sugammadex available; 2013&ndash;2014, with sugammadex available. A subsequent analysis was performed to evaluate if sugammadex replacing neostigmine as first choice reversal drug is cost-effective. Results: The introduction of a rocuronium&ndash;neostigmine&ndash;sugammadex strategy into a cisatracurium&ndash;neostigmine regimen reduced the average cost of NMB management by 36%, from &euro;20.8/case to &euro;13.3/case. Patients receiving sugammadex as a first-choice reversal drug (3%) exhibited significantly better train-of-four ratios at extubation (P<0.001) and were discharged to the surgical ward (P<0.001) more rapidly than controls. The cost-saving of sugammadex as first-choice reversal drug has been estimated to be &euro;2.9/case. Patients receiving sugammadex as rescue therapy after neostigmine reversal (3.2%) showed no difference in time to discharge to the surgical ward (P=0.44) compared to controls. No unplanned intensive care unit (ICU) admissions with rocuronium&ndash;neostigmine&ndash;sugammadex strategy were observed. The potential economic benefit in avoiding postoperative residual curarization (PORC)-related ICU admission in the 2013&ndash;2014 period was estimated at an average value of &euro;13,548 (&euro;9,316&ndash;&euro;23,845). Conclusion: Sugammadex eliminated PORC and associated morbidities. In our center, sugammadex reduced the costs of NMB management and promoted rapid turnover of patients in operating rooms, with total cost-effectiveness that counteracts the disadvantages of its high cost. Keywords: neuromuscular blockade; neuromuscular blocking agents; rocuronium; sugammadex; postoperative residual curarization; cost-benefit analysis.
Beschrijving item:1178-6981