Retrospective chart review: sugammadex vs. neostigmine/glycopyrrolate a pharmacoeconomic analysis

Purpose of Project: To ascertain the cost-effectiveness of sugammadex versus neostigmine by comparing operating room (OR) and post-anesthesia care unit (PACU) discharge times, that is, who leaves the OR and PACU faster. The overarching goal was to bring awareness to anesthesia providers, that emphasis on acquisition costs with little concern for indirect savings is misguided. Methodology: 1. Pre-intervention data collection of sugammadex, a newer paralytic, and neostigmine, a traditional paralytic, usage and trends over a seven-month period (May – December 2018). 2. Pre-intervention anesthesia provider survey about current usage of sugammadex vs neostigmine, and presentation of pre-intervention data, research, and best practices about sugammadex and neostigmine to anesthesia providers at their monthly meeting at Jersey Shore Anesthesiology Associates' corporate office. 3. Post-intervention data collection of sugammadex as compared to neostigmine usage over a two-month period (August – October 2019). 4. Statistical comparison of data to determine if the initial PowerPoint presentation had an impact on the usage of sugammadex and neostigmine and a subsequent PowerPoint presentation with a post-survey. The independent variables were (1) drugs administered (neostigmine and sugammadex) and ASA status (I-IV). The dependent variables were (1) OR total times in minutes and (2) PACU total time in minutes. Results: For the first data-set point, a total of 524 cases were analyzed (307 neostigmine/glycopyrrolate and 217 sugammadex). The mean duration time in minutes was shorter for the sugammadex group in both the OR and PACU (16.55-minute difference in the OR and 23.01-minute difference in the PACU). In patients that were considered seriously ill (ASA III and IV), the minute difference in the OR and PACU was even greater in the OR but about the same for PACU respectively (20.51-minute difference in the OR and 22.35-minute difference in the PACU for the seriously ill group). The anesthesia duration time in the OR in both the neostigmine and sugammadex group, independent of ASA, were statistically significant. For the second data-set point, a total of 568 cases were analyzed (289 neostigmine/glycopyrrolate and 279 sugammadex). Results of the independent t-test suggests that the mean duration time in minutes was longer for the sugammadex group in both the anesthesia and PACU times. The mean difference between the neostigmine and sugammadex groups for anesthesia minutes was (-20.895) and was statistically significant (t=3.3 (539); p = .001). The mean difference between the neostigmine and sugammadex group for PACU minutes was (-11.386) with a strong tendency towards statistical significance (t= 1.9 (566); p=.051). Implications for Practice: Respiratory complications, such as post-extubation respiratory failure, is the second most common type of postoperative complication. Sugammadex as compared to neostigmine has been found to decrease incidences of post-operative respiratory complications in vulnerable populations like the morbidly obese and those patients with obstructive sleep apnea. Thus, this study has important implications on healthcare quality/safety as it challenges the idea that neostigmine is ideal in every clinical situation.DNPIncludes bibliographical reference