Association Between Sugammadex Use and Risk of Postoperative Urinary Complications after Metabolic and Bariatric Surgery: A Multi-Institutional Study.

BACKGROUND

Postoperative urinary retention (POUR) is a common complication of metabolic and bariatric surgery (MBS) and is potentially exacerbated by neostigmine reversal and its required anticholinergic agents. This multi-institutional study aimed to evaluate the association between sugammadex use and postoperative urinary tract complications in this surgical population.

METHODS

This retrospective cohort study analyzed TriNetX Research Network data from adult patients undergoing laparoscopic MBS (2015-2024). Patients receiving sugammadex were compared with those receiving neostigmine with glycopyrrolate/atropine using propensity score matching. Outcomes of interest included risks of POUR (primary outcome), urinary tract infection, cystitis, and Foley catheter insertion within 30 days postoperatively.

RESULTS

After propensity score matching, 31,692 patients were analyzed. At the 30-day follow-up, sugammadex use was associated with a lower risk of POUR (odds ratio [OR] 0.20, 95% confidence interval [CI] 0.15-0.26, p < 0.001) and Foley catheter insertion (OR 0.38, 95% CI 0.26-0.55, p < 0.001), without differences in other outcomes. Temporal analysis showed that sugammadex conferred the greatest protection against POUR (OR 0.19, p < 0.001) and catheter insertion (OR 0.36, p < 0.001) during the early postoperative period (0-7 days), with no significant differences observed in other outcomes. In the late period (8-30 days), sugammadex use was associated with a delayed reduction in urinary tract infections (OR 0.67, 95% CI 0.48-0.94, p = 0.019), without differences in other outcomes.

CONCLUSION

Sugammadex use is associated with significantly reduced postoperative urinary complications following MBS, offering important clinical advantages over traditional neuromuscular blockade reversal.