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A nomogram to predict postoperative nausea and vomiting in the ward following laparoscopic bariatric surgery

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Abstract

Background

Postoperative nausea and vomiting (PONV) is a common and distressing complication of laparoscopic bariatric surgery (LBS). However, there is a lack of effective integrated prediction models for preventing and treating PONV in patients after LBS.

Methods

Based on a randomized controlled trial conducted between November 1, 2021, and May 13, 2022, we included 334 participants who underwent LBS according to the inclusion criteria. The database was divided randomly into training and validation cohorts in a ratio of 7:3. Least absolute shrinkage and selection operator plus multivariable logistic regression were used to identify independent predictors and construct a nomogram. The performance of the nomogram was assessed and validated by the area under the receiver operating characteristic curve (AUC), the concordance index (C-index), calibration plots, and a decision curve analysis (DCA). We also explored specific risk factors for PONV in patients with diabetes.

Results

The subjects were divided randomly into training (n = 234) and validation (n = 100) cohorts. Age, history of diabetes, type of surgery, and sugammadex use were incorporated to construct a nomogram prediction model. In the training cohort, the AUC and the optimism-corrected C-index were 0.850 [95% confidence interval (CI) 0.801–0.899] and 0.848, while in the validation cohort they were 0.847 (95% CI 0.768–0.925) and 0.844, respectively. The calibration plots showed good agreement between the predicted and actual observations. The DCA results demonstrated that the nomogram was clinically useful. The type of surgery, sugammadex use, and insulin level at 120 min were predictors of PONV in patients with diabetes with an AUC of 0.802 (95% CI 0.705–0.898).

Conclusions

We developed and validated a prediction model for PONV in patients after LBS. A risk factor analysis of PONV in patients with diabetes provides clinicians with a more precise prophylactic protocol.

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Acknowledgements

We would like to thank Editage (www.editage.cn) for English language editing.

Funding

None.

Author information

Author notes

  1. Xiahao Ding, Jinxing Che, and Siyang Xu have contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China

    Xiahao Ding, Jinxing Che, Siyang Xu, Dapeng Chen, Tianming Zha, Gulibositan Abudurousuli & Bo Gui

  2. Department of Anesthesiology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China

    Xiahao Ding

  3. Department of Anesthesiology, Huai’an Maternity and Child Healthcare Hospital, Huai’an, China

    Jinxing Che

  4. Department of Anesthesiology, Jiangsu Province Official Hospital, Nanjing, China

    Siyang Xu

  5. Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China

    Dapeng Chen

  6. Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

    Hui Liang

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Correspondence to Bo Gui.

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Xiahao Ding, Jinxing Che, Siyang Xu, Dapeng Chen, Tianming Zha, Gulibositan Abudurousuli, Hui Liang and Bo Gui have no conflicts of interest or financial ties to disclose.

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Supplementary Information

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Supplementary file1 (TIF 8537 kb) Supplementary Fig. 1. Flow diagram of study design. ICU = intensive care units.

464_2023_10483_MOESM2_ESM.tiff

Supplementary file2 (TIFF 4651 kb) Supplementary Fig. 2. An application example based on the calculation of the nomogram prediction model. As an example, we randomly selected one patient from the PHCBS database. She was 19 years old and non-diabetes. She was received LSG without sugammadex. By drawing a line up toward the points for each of the variables this patient will have 94 points (age), 99 points (history of diabetes), 89 points (sugammadex use), and 89 points (type of surgery), giving a total of 371 points (at the bottom of the figure), and a probability of PONV of 82.2%. PONV = Postoperative nausea and vomiting; LSG = Laparoscopic sleeve gastrectomy; LSG-DJB = Laparoscopic sleeve gastrectomy plus duodenojejunal bypass; LSG-JJB = Laparoscopic sleeve gastrectomy plus jejunojejunal bypass; OAGB = One anastomosis gastric bypass.

Supplementary file3 (TIFF 3529 kb) Supplementary Fig. 3. Flow diagram for patients with diabetes.

Supplementary file4 (DOCX 43 kb)

Supplementary file5 (DOCX 44 kb)

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Ding, X., Che, J., Xu, S. et al. A nomogram to predict postoperative nausea and vomiting in the ward following laparoscopic bariatric surgery. Surg Endosc 37, 9217–9227 (2023). https://doi.org/10.1007/s00464-023-10483-2

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