The Role of Aprepitant in Prevention of Postoperative Nausea and Vomiting After Bariatric Surgery

  • Isaac W. Therneau
  • Erin E. Martin
  • Juraj Sprung
  • Todd A. Kellogg
  • Darrell R. Schroeder
  • Toby N. Weingarten
Original Contributions

Abstract

Background

Postoperative nausea and vomiting (PONV) is common with bariatric surgery. We examined the PONV rate in bariatric surgical patients who received triple antiemetic prophylaxis (dexamethasone, droperidol, and ondansetron) with and without antiemetic aprepitant.

Methods

Medical records of female patients undergoing laparoscopic bariatric surgery from January 1, 2014, to July 28, 2016, were reviewed for PONV episodes during 48 postoperative hours.

Results

In total, 338 patients received triple antiemetic, of whom 172 (51%) also received aprepitant. Rates of PONV in the postanesthesia care unit (PACU) among patients with and without aprepitant therapy were 11 vs 17% (P = .09). Within 1 h after PACU discharge, fewer patients in the aprepitant group had PONV (19 vs 31%; odds ratio [OR] [95% CI], 0.5 [0.30–0.80]; P = .007). During the first 48 postoperative hours, PONV rates were similar between the groups (68 and 66%; P = .73), but fewer emesis episodes occurred in the aprepitant group (6 vs 13%; OR [95% CI], 0.45 [0.21–0.95]; P = .04). Analyses were also performed with a subset of patients matched on propensity for receiving aprepitant. In this subset, OR estimates quantifying aprepitant effect on PONV were similar to those obtained from multivariable regression analyses.

Conclusion

Addition of aprepitant to a multimodal antiemetic prophylactic regimen may be associated with significant reduction of PONV during early recovery and potentially with reduced incidence of vomiting during the first 48 postoperative hours. The high PONV rate in the first 48 postoperative hours is suggestive that introduction of scheduled anti-PONV prophylactic treatment may be desirable.

Keywords

Aprepitant Bariatric surgery Postoperative nausea and vomiting 

Abbreviations

CI

Confidence interval

NK-1

Neurokinin-1

OR

Odds ratio

OSA

Obstructive sleep apnea

PACU

Postanesthesia care unit

PONV

Postoperative nausea and vomiting

SD

Standard deviation

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Isaac W. Therneau
    • 1
  • Erin E. Martin
    • 1
  • Juraj Sprung
    • 1
  • Todd A. Kellogg
    • 2
  • Darrell R. Schroeder
    • 3
  • Toby N. Weingarten
    • 1
  1. 1.Department of Anesthesiology and Perioperative MedicineMayo ClinicRochesterUSA
  2. 2.Division of Subspecialty General SurgeryMayo ClinicRochesterUSA
  3. 3.Division of Biomedical Statistics and InformaticsMayo ClinicRochesterUSA

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