Does Sugammadex Decrease Length of Stay in Bariatric Surgery? Experience from an MBSAQIP Comprehensive Bariatric Center

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BACKGROUND: Residual effects from general anesthesia can delay the time until oral intake and ambulation. Reversal with Sugammadex has been shown to improve outcomes and decrease post-operative nausea and vomiting. The benefits amongst the bariatric population have not been ascertained. We hypothesized that the use of Sugammadex for reversal will decrease the length of stay (LOS). METHODS AND PROCEDURES: This is a single center retrospective review of 961 patients who underwent elective bariatric surgery from January 2023 to January 2025. Inclusion criteria were any patient undergoing elective bariatric surgery who received either Sugammadex or neostigmine. Our exclusion criteria were any emergent or open procedures. The decision to administer either Sugammadex or neostigmine was up to the discretion of the anesthesiologist. Sugammadex was used in 355 patients and neostigmine for reversal in 606 patients. The primary outcome was the length of stay. Multivariable regression models were used to adjust various variables. RESULTS: Median LOS was 2 nights in the Sugammadex group versus 3 nights in the neostigmine group. The proportion of prolonged stays (> 2 nights) was 27.9% for Sugammadex (p = 0.007) versus 72.1% for neostigmine (p = 0.004). In multivariable logistic regression, sugammadex was independently associated with lower odds of prolonged LOS (OR = 0.55, 95% CI 0.37-0.82, p = 0.004) while neostigmine was associated with increased odds of prolonged LOS (OR = 1.866, 95% CI 1.23-2.83, p = 0.003). Higher complexity procedures and higher BMI were also independent predictors of increased LOS. CONCLUSION: Sugammadex use was associated with significantly lower odds of prolonged hospital stay following elective bariatric surgery. Procedure complexity and higher BMI were also independent predictors. Further prospective studies are warranted to confirm these findings.

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