A Comprehensive Approach for the Prevention of Nausea and Vomiting Following Sleeve Gastrectomy: a Randomized Controlled
- PDF / 591,998 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 8 Downloads / 184 Views
ORIGINAL CONTRIBUTIONS
A Comprehensive Approach for the Prevention of Nausea and Vomiting Following Sleeve Gastrectomy: a Randomized Controlled Trial Konstantinos Spaniolas 1 & Lizhou Nie 2 & Daryn Moller 3 & Talar Tatarian 1 & Anthony Hesketh 1 & Jie Yang 2 & Salvatore Docimo 1 & Andrew Bates 1 & Tong J. Gan 3 & Aurora Pryor 1 Received: 30 March 2020 / Revised: 15 June 2020 / Accepted: 17 June 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords PONV . Nausea . Enhanced recovery . Sleeve gastrectomy
Introduction
* Konstantinos Spaniolas [email protected] 1
Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
2
Department of Family, Population & Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
3
Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
Postoperative nausea and vomiting (PONV) is a common occurrence following any surgical procedure, but they are particularly important for patients undergoing bariatric surgery. Despite their short hospital stay, more than half of bariatric patients report PONV during their hospital stay [1, 2]. Importantly, PONV can have a significant effect on healthcare
Data Loading...
