NMBA Reversal and Postoperative Urinary Retention

The Choice of Neuromuscular Blockade Reversal Agent and Its Effects on Postoperative Urinary Retention: A Retrospective Cohort Study

In this single-center retrospective cohort study of adult patients who underwent surgery under general anesthesia at Beth Israel Deaconess Medical Center between September 2016 and January 2024, the association between the choice of neuromuscular blocking agent (NMBA) reversal strategy, comparing sugammadex with neostigmine (combined with a muscarinic antagonist), and postoperative urinary retention (POUR) will be evaluated. In secondary analyses, the effects of NMBA reversal strategy and POUR on costs of care and unplanned hospital visits will be analyzed.

Inclusion Criteria:

• Adult patients
• Non-urinary system surgery
• General anesthesia
• Use of rocuronium or vecuronium for neuromuscular blockade
• Neuromuscular blockade reversal with sugammadex or neostigmine (with atropine and/or glycopyrrolate)
• Postoperative admission to the post-anesthesia care unit (PACU)

Exclusion Criteria:

• American Society of Anesthesiologists (ASA) physical status ≥ V
• Emergency reversal with sugammadex (≥ 16 mg/kg of sugammadex)
• Presence of foley or suprapubic catheter before or after the procedure
• Prior history of bladder resection surgery
• Observations with missing data for pre-specified confounding variables