Sugammadex Utilization: A Systems Based Practice & Health System Analysis

Document Type

Conference Proceeding

Publication Date

10-12-2025

Abstract

Background: At Corewell Health, providing affordable care to our patients is a priority, and reducing drug expenses has been a key focus area in trying to achieve this. Sugammadex has been identified as a major driver of drug costs in recent years. In response, the health system has implemented financial incentives for the private anesthesiology group to minimize sugammadex use outside of recommended guidelines and to encourage greater utilization of neostigmine. We are aiming to evaluate changes in sugammadex utilization since the removal of pharmacy approval requirements and its subsequent introduction into operating room Omnicells. Additionally, we seek to understand how hospital administration and the pharmacy department are assessing adherence to usage guidelines and overall performance.
Methods: Data from the Multicenter Perioperative Outcomes Group (MPOG) Data Direct was utilized to determine the annual number of cases in which nondepolarizing neuromuscular blocking agents were administered and where sugammadex was used for reversal intraoperatively. This was then divided by the total number of cases receiving any form of neuromuscular blockade reversal (sugammadex or neostigmine) to obtain a percentage of cases using sugammadex. The same method was used to determine the percentage of cases that utilized neostigmine in May and June of 2024, and we compared these percentages with pharmacy-reported rates. Additionally, we compared the percentage of cases in which sugammadex was used within guidelines based on a previously reported 2022 retrospective chart review of 100 randomly selected patients from 2020 with the 2024 rates reported by the Corewell Health pharmacy department.
Results: Sugammadex use in cases requiring neuromuscular blockade reversal increased from 37% in 2020 to 85% in 2021, 98% in 2022, and 99% in 2024. According to a 2022 retrospective chart review, adherence to hospital guidelines for sugammadex administration was 87% in March and June 2020, and 92% in September 2020. In contrast, the pharmacy department reported that compliance with hospital guidelines was 80% in May 2024, and 78% in June and July 2024. When modified criteria incorporating train-of-four counts were applied, adherence rates were reported at 88% in May, 91% in June, and 90% in July 2024. A comparison of MPOG data and pharmacy-reported rates of sugammadex and neostigmine use for May and June 2024 is provided in the table below.
Conclusion: Sugammadex utilization has increased significantly in recent years with a subsequent decline in neostigmine use, thus leading to rising drug costs for neuromuscular blockade reversal. However, adherence to hospital guidelines for sugammadex administration has remained relatively stable. The discrepancy between MPOG data and pharmacy-reported utilization rates raises concerns, especially given the financial incentives tied to guideline adherence. Further investigation is warranted to address these inconsistencies and ensure accurate performance evaluation.

Comments

American Society of Anesthesiologists, The Anesthesiology Meeting, October 10-14, 2025, San Antonio, TX

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