Association of Sugammadex Exposure with Venous Thrombosis Risk Following Primary Total Knee Arthroplasty: A Multi-Institutional Retrospective Analysis.

PURPOSE: Although sugammadex may facilitate early postoperative mobilization and transiently influence coagulation parameters, its association with venous thromboembolism (VTE) risk after total knee arthroplasty (TKA) remains unclear.

PATIENTS AND

METHODS

This multi-institutional retrospective study utilized the TriNetX research network to identify individuals aged ≥45 years who received rocuronium and underwent primary TKA between 2010 and 2024. Patients were categorized by reversal agent: sugammadex or neostigmine. The neostigmine group served as the active comparator throughout the study. After 1:1 propensity score matching, 22,844 pairs were analyzed. The primary outcome was VTE incidence at 14 days. Secondary outcomes included deep vein thrombosis (DVT), pulmonary embolism (PE), pneumonia, urinary tract infection (UTI), postoperative nausea/vomiting (PONV), and mortality at 14 and 90 days.

RESULTS

Sugammadex use was associated with a significantly lower risk of VTE at 14 days (odds ratio[OR] 0.60, 95%confidence interval [CI] 0.49-0.74, p<0.001; absolute risk difference, -0.41 percentage points), with lower risks observed for both DVT (OR 0.65, p=0.001) and PE (OR 0.58, p=0.001). This association persisted at 90 days (OR 0.72, 95% CI 0.62-0.84, p<0.001; absolute risk difference, -0.50 percentage points). Sugammadex was also associated with lower rates of pneumonia (p=0.018), UTI (p<0.001), and PONV (p=0.005) at 14 days, without significant differences in mortality. Sensitivity and subgroup analyses yielded results consistent with the primary findings.

CONCLUSION

Use of sugammadex was associated with a decreased risk of VTE after primary TKA. Given the observational design and potential for residual confounding, these hypothesis-generating findings warrant confirmation through prospective randomized trials to elucidate the underlying mechanisms and clinical implications.