Sugammadex is associated with shorter hospital length of stay after open lobectomy for lung cancer: A retrospective observational study

Background: Sugammadex is associated with few postoperative complications. Postoperative pulmonary complications are related to prolonged hospitalizations. Present study explored whether the use of sugammadex could reduce postoperative complications and thereby reduce hospital length of stay (LOS) after lung surgery. Methods: We reviewed the medical records of patients who underwent elective open lobectomy for lung cancer from January 2010 to December 2015. Patients were divided into the sugammadex group and pyridostigmine group.The primary outcome was hospital LOS and secondary outcomes were postoperative complications and overall survival at 1 year. The cohort was subdivided into patients with and without prolonged LOS to explore the effects of sugammadex on outcomes in each group. Risk factors for prolonged LOS were determined via multivariate analyses. After propensity score matching, 127 patients were assigned to each group. Results: Median hospital LOS was shorter (10.0 vs. 12.0 days) and the incidence of postoperative atelectasis was lower (18.1 vs. 29.9%) in the sugammadex group. However, no significant difference in overall survival between the groups was seen over 1 year (hazard ratio, 0.967; 95% confidence interval, 0.363 to 2.577). Sugammadex was a predictor related to LOS (exponential coefficient 0.88; 95% CI 0.82–0.95) and resulted in a shorter LOS in patients without a prolonged LOS). Among patients undergoing open lung lobectomy for lung cancer, compared to pyridostigmine, neuromuscular reversal with sugammadex resulted in a short hospital LOS and a lower incidence of postoperative complications, but showed a similar mortality. Conclusions: Our data suggest that sugammadex is a preferable agent for neuromuscular blockade (NMB) reversal than cholinesterase inhibitors in this patient population.Trial registration: This study registered in the Clinical Research Information Service of the Korea National Institute of Health (approval number: KCT0004735, Date of registration: 21 January 2020, Retrospectively registered).