title: The use of sugammadex for bariatric surgery: analysis of recovery time from neuromuscular blockade and possible economic impact.
abstract: BACKGROUND
  Neuromuscular block (NMB) monitoring and use of reversal agents accelerate the recovery time and improve the workflow in the operating room. We aimed to compare recovery times after sugammadex or neostigmine administration, and estimate the time spent in operating theater and the possible economic impact of a faster recovery, in morbidly obese patients undergoing bariatric surgery.
  
  
  METHODS
  We conducted a retrospective study that analyzed data from records of morbidly obese patients (body mass index >40 kg/m(2)) undergoing elective laparoscopic bariatric surgery in which sugammadex or neostigmine were used to reverse NMB. Patients were divided in two groups: group 1 (sugammadex group [SUG]) received rocuronium and sugammadex for reversal and group 2 (neostigmine group [NEO]) received either rocuronium or cisatracurium and neostigmine. Data are presented as mean (standard deviation).
  
  
  RESULTS
  Compared with NEO, SUG group showed shorter times to achieve train-of-four ratio of 0.9 (P<0.05) and an Aldrete score of 10 (P<0.05), a higher cost (€146.7 vs €3.6 [P<0.05]), plus a remarkable less duration of operating theater occupancy (P<0.05). Sugammadex cost accounted for 2.58% of the total cost per surgery, while neostigmine cost accounted for 0.06%. Total time saved in SUG group was 19.4 hours, which could be used to perform 12 extra laparoscopic sleeve gastrectomies.
  
  
  CONCLUSIONS
  Reversal from NMB was significantly faster with sugammadex than with neostigmine. Although sugammadex was substantially more expensive, duration of operating theater occupancy was reduced with potentially workflow increase or personnel reduced cost.
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatologic Sciences, University Federico II, Naples.
authors.forename: Edoardo
authors.initials: E
authors.lastname: De Robertis
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatologic Sciences, University Federico II, Naples.
authors.forename: Geremia
authors.initials: G
authors.lastname: Zito Marinosci
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatologic Sciences, University Federico II, Naples.
authors.forename: Giovanni Marco
authors.initials: GM
authors.lastname: Romano
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Salerno.
authors.forename: Ornella
authors.initials: O
authors.lastname: Piazza
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatologic Sciences, University Federico II, Naples.
authors.forename: Michele
authors.initials: M
authors.lastname: Iannuzzi
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatologic Sciences, University Federico II, Naples.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cirillo
authors.affiliation: Institute for Research on Innovation and Services for Development, National Research Council, Naples, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: De Simone
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatologic Sciences, University Federico II, Naples.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Servillo
keywords: PORC; laparoscopic surgery; pharmacoeconomics; reversal agents