Effect of neuromuscular blockade reversal on post-operative urinary retention following inguinal herniorrhaphy.

PURPOSE: This study aims to define the risk of post-operative urinary retention (POUR) following inguinal hernia repair in those that received sugammadex compared to anticholinesterase. METHODS: Adults undergoing inguinal herniorrhaphy from January 2019 to July 2022 with at least 30-day follow-up receiving rocuronium or edrophonium and reversed with an anticholinesterase or sugammadex were included. 1-to-2 propensity score matched models were fitted to evaluate the treatment of effect of sugammadex vs. anticholinesterase on POUR, adjusting for patient comorbidities, ASA class, wound class, operative laterality, urgency of case, and open versus minimally invasive repair. RESULTS: 3345 patients were included in this study with 1101 (32.9%) receiving sugammadex for neuromuscular blockade reversal. The 30-day rate of POUR was 2.8%; 1.4% in the sugammadex and 4.4% in the anticholinesterase group. After propensity score matching, patients receiving sugammadex had significantly lower risk of POUR compared to anticholinesterase overall (OR 0.340, p < 0.001, 95% CI 0.198-0.585), in open (OR 0.296, p = 0.013, 95% CI 0.113-0.775) and minimally invasive cases (OR 0.36, p = 0.002, 95% CI 0.188-0.693), unilateral (OR 0.371, p = 0.001, 95% CI 0.203-0.681) and bilateral repairs (OR 0.25, p = 0.025, 95% CI 0.074-0.838), elective (OR 0.329, p < 0.001, 95% CI 0.185-0.584) and clean cases (OR 0.312, p < 0.001, 95% CI 0.176-0.553). CONCLUSIONS: The incidence of 30-day new onset POUR was 2.8%. Sugammadex was associated with significantly lower risk of POUR after inguinal herniorrhaphy compared to anticholinesterase overall and when stratifying by operative modality, laterality, and wound class.

Risk factors and natural history of bedside percutaneous endoscopic versus fluoroscopy-guided gastrostomy tubes in intensive care unit patients.

INTRODUCTION: There is a paucity of literature comparing patients receiving bedside placed percutaneous endoscopic gastrostomy (PEG) versus fluoroscopic-guided percutaneous gastrostomy tubes (G-tube) in an intensive care unit (ICU) setting. This study aims to investigate and compare the natural history and complications associated with PEG versus fluoroscopic G-tube placement in ICU patients. METHODS: All adult patients admitted in the ICU requiring feeding tube placement at our center from 1/1/2017 to 1/1/2022 with at least 12-month follow up were identified through retrospective chart review. Adjusting for patient comorbidities, hospital factors, and indications for enteral access, a 1-to-2 propensity score matched Cox proportional-hazards model was fitted to evaluate the treatment effect of bedside PEG tube placement versus G-tube placement on patient 1-year complication, readmission, and death rates. Major complications were defined as those requiring operative or procedural intervention. RESULTS: This study included 740 patients, with 178 bedside PEG and 562 fluoroscopic G-tube placements. The overall rate of complication was 22.3% (13% PEG, 25.2% G-tube, P = 0.003). The major complication rate was 11.2% (8.5% PEG, 12.1% G-tube, P = 0.09). Most common complications were tube dysfunction (16.7% PEG; 39.4% G-tube; P = 0.04) and dislodgement (58.3% PEG; 40.8% G-tube). After propensity score matching, G-tube recipients had significantly increased risk for all-cause (HR 2.7, 95% CI 1.56-4.87, P < 0.001) and major complications (HR 2.11, 95% CI 1.05-4.23, P = 0.035). There were no significant differences in 1-year rates of readmission (HR 0.90, 95% CI 0.58-1.38, P = 0.62) or death (HR 1.00, 95% CI 0.70-1.44, P = 0.7). CONCLUSIONS: The overall rate of complications for ICU patients requiring feeding tube in our cohort was 22.3%. ICU patients receiving fluoroscopic-guided percutaneous gastrostomy tube placement had significantly elevated risk of 1-year all-cause and major complications compared to those undergoing bedside PEG.