Reversal With Sugammadex Is Associated With Early Return of Bowel Function After Right Colon Resections

Introduction: Sugammadex has been shown to have fewer anticholinergic side effects compared to neostigmine/glycopyrrolate when used for reversal of neuromuscular blockade. However, the impact on return of bowel function in a higher-acuity patient population is unknown. Here, we aim to evaluate if sugammadex is associated with faster return of bowel function after a right colon resection. Methods: A comparative retrospective cohort study at a tertiary referral center among patients who underwent right colon resection between 2020 and 2022 was performed. Patient demographics, reversal agents, and postoperative bowel function were recorded. Early return of bowel function was defined as flatus on ≤ postoperative day (POD) 2. Results: A total of 348 patients had a median return of bowel function on POD 3.0 (interquartile range, IQR: 3.0-4.0). Approximately 21% of patients had early return of bowel function. These patients were more likely to receive sugammadex for neuromuscular blockade reversal, have malignancy as their surgical indication, undergo a laparoscopic approach, and have a nonopioid based pain regimen. Multivariate analysis showed that reversal with sugammadex was an independent factor for having early bowel function (adjusted odds ratio, OR_adj 3.30, 95% confidence interval [CI]: 1.44-7.60), whereas open surgical approach (OR_adj 0.30, 0.13-0.68) and patient-controlled analgesia (OR_adj 0.29, 0.11-0.79) were independent risk factors against having early bowel function. Propensity score matched cohort was created with a total of 76 patients. Patients reversed with sugammadex were more likely to have early return of bowel function when compared to the neostigmine/glycopyrrolate group (OR 2.89, 1.01-8.23, 39.5% versus 18.4%, P < 0.05). Conclusions: In this study, we associated the use of sugammadex for neuromuscular blockade reversal with early return of bowel function. Using sugammadex for reversal has the potential to reduce postoperative ileus among colectomy patients.