Effect of sugammadex on the prevention of postoperative lung atelectasis in patients undergoing metabolic and bariatric surgery: a retrospective study.

BACKGROUND

Pulmonary atelectasis is a significant complication of metabolic and bariatric surgery (MBS). Sugammadex enables rapid neuromuscular blockade reversal compared to neostigmine, but its impact on atelectasis prevention remains unclear.

METHODS

This retrospective multicenter study used the TriNetX database to analyze adult patients who underwent MBS between 2010 and 2024. Patients receiving rocuronium were divided into sugammadex and control (i.e., neostigmine use) groups. After propensity score matching, the outcomes were assessed at the 30-day follow-up. The primary outcome was the risk of pulmonary atelectasis, while secondary outcomes included pneumonia, respiratory failure, deep vein thrombosis (DVT), and intensive care unit (ICU) admission.

RESULTS

Among 19,606 propensity-matched pairs, sugammadex significantly reduced the risk of pulmonary atelectasis (0.83% vs. 1.33%, odds ratio [OR]: 0.62, 95% confidence interval [CI]: 0.51-0.76, p<0.001). The secondary outcomes showed no significant differences in pneumonia (0.36% vs. 0.45%, p=0.177), respiratory failure (0.36% vs. 0.40%, p=0.460), DVT (0.19% vs. 0.17%, p=0.722), or ICU admission (0.67% vs. 0.81%, p=0.111). Subgroup analyses demonstrated consistent protective effects of sugammadex against pulmonary atelectasis across different patient populations (with or without sleep apnea) and institutional settings (academic vs. non-academic centers). Female patients receiving sugammadex experienced significant reductions in both pulmonary atelectasis (OR: 0.59, p<0.001) and respiratory failure (OR: 0.64, p=0.028), whereas the benefit in male patients was not statistically significant.

CONCLUSION

Sugammadex use was associated with a 38% reduction in postoperative pulmonary atelectasis compared to neostigmine use, suggesting that it may be a beneficial strategy for improving respiratory outcomes in patients undergoing MBS.