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The impact of nausea on post-operative outcomes in bariatric surgery patients

  • 2019 SAGES Oral
  • Published:
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Abstract

Introduction

The evaluation and treatment of post-operative nausea in bariatric surgery patients has not been standardized. In this patient population, nausea can have a significant impact on quality outcomes. The primary objective of this study was to determine the impact of nausea on post-operative outcomes in bariatric surgery patients.

Methods

A retrospective chart review was conducted of adult patients who underwent a primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (LSG) between 2014 and 2017 at a single institution. Patients with post-operative nausea were identified. Post-operative nausea was defined as patients who had nausea that was documented by multiple providers, and which interfered with their oral intake. Demographic variables were identified for patients with and without documented nausea. Univariate analyses were performed to determine the impact of post-operative nausea on patients’ length of stay, readmissions, reoperations, and overall complications.

Results

There were 449 primary bariatric surgery patients in the study period, 197 (43.9%) LRYGB and 252 (56.1%) LSG. Of these patients, 160 (35.6%) had documented post-operative nausea. Demographic factors that contributed to post-operative nausea included African-American race and undergoing a LSG (p = 0.004 and p = 0.01, respectively). Patients who underwent a LSG had a 2.0 times increased risk of post-operative nausea compared to LRYGB (p = 0.01). Patients with documented nausea had a statistically significant increased length of stay (2.4 ± 1.9 days vs. 1.6 ± 1.0 days; p ≤ 0.01). Documented nausea patients had an increased incidence of Emergency Department visits within 30 days post-operatively (p = 0.02).

Conclusions

Post-operative nausea was more likely in patients who underwent a sleeve gastrectomy. Gastric bypass and sleeve gastrectomy patients with documented nausea had an increased length of stay and Emergency Department visits. These results highlight the need for a metric to more accurately measure post-operative nausea, as well as a standardized anti-emetic treatment pathway to improve quality outcomes.

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References

  1. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, Singh GM, Gutierrez HR, Lu Y, Bahalim AN, Farzadfar F, Riley LM, Ezzati M (2011) National, regional and global trends in body-mass index since 1980: systemic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 377:557–567

    Article  Google Scholar 

  2. Puzziferri N, Roshek TB, Mayo G, Gallagher R, Belle SH, Livingston EH (2014) Long-term follow-up after bariatric surgery: a systematic review. JAMA 312(9):934–942

    Article  CAS  Google Scholar 

  3. Chang SH, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA (2014) The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis. JAMA Surg 149(3):275–287

    Article  Google Scholar 

  4. Brolin RE (2011) Bariatric surgery and long-term control of morbid obesity. JAMA 288(22):2793–2796

    Article  Google Scholar 

  5. Nguyen NT, Goldman C, Rosenquist CJ, Arango A, Cole CJ, Lee SJ, Wolfe BM (2001) Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 243(3):279–291

    Article  Google Scholar 

  6. Halliday TA, Sundqvist J, Hultin M, Wallden J (2017) Post-operative nausea and vomiting in bariatric surgery patients: an observational study. Acta Anaesthesiol Scand 61:471–479

    Article  CAS  Google Scholar 

  7. Apfel CC, Heidrich FM, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP, Zhang K, Cakmakkaya OS (2012) Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth 109(5):742–753

    Article  CAS  Google Scholar 

  8. Rodseth RN, Gopalan PD, Cassimjee HM, Goga S (2010) Reduced incidence of postoperative nausea and vomiting in black South Africans and its utility for a modified risk scoring system. Anesth Analg 110:1591

    Article  Google Scholar 

  9. Gan TJ (2007) Mechanisms underlying postoperative nausea and vomiting and neurotransmitter receptor antagonist-based pharmacotherapy. CNS Drugs 21:813–833

    Article  CAS  Google Scholar 

  10. Pilone V, Tramontano S, Di Micco R, Monda A, Hasani A, Izzo G, Vitiello A, Caprio MG, Cuocolo A, Forestieri P (2013) Gastric emptying after sleeve gastrectomy: statistical evidence of a controlled prospective study with gastric scintigraphy. Minerva Chir 68(4):385–392

    CAS  PubMed  Google Scholar 

  11. Sista F, Abruzzese V, Clementi M, Carandina S, Cecilia M, Amicucci G (2017) The effect of sleeve gastrectomy on GLP-1 secretion and gastric emptying: a prospective study. Surg Obes Relat Dis 13(1):7–14

    Article  Google Scholar 

  12. King AB, Spann MD, Jablonski P, Wanderer JP, Sandberg WS, McEvoy MD (2018) An enhanced recovery program for bariatric surgical patients significantly reduces perioperative opioid consumption and postoperative nausea. Surg Obes Relat Dis 14:849–856

    Article  Google Scholar 

  13. Macario A, Weinger M, Carney S, Kim A (1999) Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 89:652–658

    CAS  PubMed  Google Scholar 

  14. Dzwonczyk R, Weaver TE, Puente EG, Bergese SD (2012) Postoperative nausea and vomiting prophylaxis from an economic point of view. Am J Ther 19(1):502–514

    Article  Google Scholar 

  15. Major P, Stefura T, Malczak P, Wysocki M, Witowski J, Kulawik J, Wierdak M, Pisarska M, Pedziwiatr M, Budzysnki A (2018) Postoperative care and functional recovery after laparoscopic sleeve gastrectomy vs. laparoscopic roux-en-y gastric bypass among patients under ERAS protocol. Obes Surg 28:1031–1039

    Article  Google Scholar 

  16. Chen J, Mackenzie J, Zhai Y, O’Loughlin J, Kholer R, Morrow E, Glasgow R, Volckmann E, Ibele A (2017) Preventing returns to the emergency department following bariatric surgery. Obes Surg 27(8):1986–1992

    Article  Google Scholar 

  17. Stevens H, Wells E, Ross R, Stricklen A, Ghaferi AA (2018) Patient perspective on emergency department self-referral after bariatric surgery. Surg Obes Relat Dis 14:674–681

    Article  Google Scholar 

  18. Morton J, Brethauer S, Fraker T, Bradford J, Huffman K, Berger E, An Petrick, Ko C (2016) Decreasing readmissions through opportunities provided (DROP): the first national quality improvement collaborative from the metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP). Surg Obes Relat Dis 12(7):S1–S2

    Article  Google Scholar 

  19. Olumuyiwa AB, Oluwole O, Khaw RR (2018) Perioperative antiemetic therapy for fast-track laparoscopic bariatric surgery. Obes Surg 28:1296–1301

    Article  Google Scholar 

  20. Karlsson A, Wendel K, Polits S, Gislason H, Hedenbro JL (2016) Preoperative nutrition and postoperative discomfort in an ERAS setting: a randomized study in gastric bypass surgery. Obes Surg 26:743–748

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Sarah Suh, Melissa Helm, Tammy L. Kindel, Matthew I. Goldblatt, Jon C. Gould & Rana M. Higgins

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  1. Sarah Suh
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  2. Melissa Helm
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  3. Tammy L. Kindel
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  4. Matthew I. Goldblatt
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Correspondence to Rana M. Higgins.

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Disclosures

Dr. Rana Higgins is a proctor for Intuitive Surgical and a speaker for WL Gore. Dr. Matthew I. Goldblatt is a speaker and consultant for WL Gore and Medtronic, a consultant for Allergan, and receives research funding from Bard and Merck. Dr. Jon C. Gould is a consultant for Torax Medical. Ms. Sarah Suh, Ms. Melissa Helm, and Dr. Tammy L. Kindel have nothing to disclose.

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Suh, S., Helm, M., Kindel, T.L. et al. The impact of nausea on post-operative outcomes in bariatric surgery patients. Surg Endosc 34, 3085–3091 (2020). https://doi.org/10.1007/s00464-019-07058-5

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  • DOI: https://doi.org/10.1007/s00464-019-07058-5

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