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Obesity Surgery
Published in: Obesity Surgery 11/2020

01-11-2020 | Nausea | Original Contributions

A Comprehensive Approach for the Prevention of Nausea and Vomiting Following Sleeve Gastrectomy: a Randomized Controlled Trial

Authors: Konstantinos Spaniolas, Lizhou Nie, Daryn Moller, Talar Tatarian, Anthony Hesketh, Jie Yang, Salvatore Docimo, Andrew Bates, Tong J. Gan, Aurora Pryor

Published in: Obesity Surgery | Issue 11/2020

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Abstract

Background

Postoperative nausea and vomiting (PONV) following sleeve gastrectomy (SG) is a common occurrence. The effect of specific interventions in PONV prevention within enhanced recovery pathways remains unclear. The aim of this study was to evaluate the impact of a comprehensive approach for the prevention of PONV on patient outcomes and hospital resource utilization.

Methods

A prospective randomized trial was conducted for patients undergoing SG. The intervention group received aprepitant and transdermal scopolamine preoperatively followed by ondansetron and dexamethasone intraoperatively, with total intravenous anesthesia. The control group received inhalational anesthetic and two intraoperative antiemetics without preoperative prophylaxis. The primary endpoint was a PONV-related delay in hospital discharge.

Results

Eighty-three patients completed the study (41 in the intervention and 42 in the control group). Eighty-nine percent of patients were discharged home on the first postoperative day. Four patients in the control group and none in the intervention group experienced a PONV-related delay in discharge (9.5% vs 0, p = 0.119). Intervention patients reported significantly lower PONV scores at all in-hospital time points examined (p = 0.0392 for verbal scores and p < 0.0001 for Rhodes Index) and significantly higher self-rated quality of recovery at 24 h (Quality of Recovery-15 instrument, p < 0.05).

Conclusions

A multilevel approach to PONV leads to significantly lower severity of PONV and improved self-reported quality of recovery, compared with control. PONV-related readmissions, ED visits, and discharge delays were uncommon within the overall enhanced recovery cohort.
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Metadata
Title
A Comprehensive Approach for the Prevention of Nausea and Vomiting Following Sleeve Gastrectomy: a Randomized Controlled Trial
Authors
Konstantinos Spaniolas
Lizhou Nie
Daryn Moller
Talar Tatarian
Anthony Hesketh
Jie Yang
Salvatore Docimo
Andrew Bates
Tong J. Gan
Aurora Pryor
Publication date
01-11-2020
Publisher
Springer US
Published in
Obesity Surgery / Issue 11/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-020-04795-8

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