Adam C Celio, MD, Matthew B Burruss, MD, Walter J Pories, MD, Konstantinos Spaniolas, MD. East Carolina University
Introduction: The most common reason for readmission after bariatric surgery is postoperative nausea/vomiting (PONV) and associated dehydration. While previous studies have attempted to investigate PONV after bariatric surgery, this hasn’t been objectively measured and procedure-based comparisons aren’t reported. The aim of this study is to compare the incidence and severity of PONV between patients undergoing laparoscopic sleeve gastrectomy (SG) and laparoscopic gastric bypass (GB).
Methods: This is a prospective, observational cohort study that evaluated all patients who underwent SG or GB at our tertiary care institution between July 2015 and June 2016. Patients undergoing revisional surgery or additional operations concurrent to bariatric surgery, including cholecystectomy or hiatal hernia repair, were excluded from the study. A standard PONV management protocol was in place during this study. Patients were asked to grade their nausea on a 10 point Likert scale at 2 hours postoperatively and the morning of each postoperative day (POD). Further data was collected from chart review including medications used, length of stay, and readmission within 30 days.
Results: There were 65 patients that matched the inclusion criteria, of which 29 underwent SG and 36 underwent GB. There were no significant differences in age (46.5±9.7 vs 43.1±12.5, p=0.198), BMI (46.9±6.1 vs 50.5±10.1, p=0.294), ASA classification (2.8±0.4 vs 2.7±0.5, p=0.380), or male gender (24.1% vs 11.1%, p=0.164) when comparing SG and RYGB patients. There was no difference in the number of prophylactic PONV medications used before or during surgery (1.7±0.8 vs 1.7±0.8, p=0.851). Results of patient’s nausea score (0-10), number of antiemetic and opioid medications (morphine equivalents) used are displayed in the table. There were no differences in LOS (2.6±1.3 vs 2.3±0.5, p=0.919) or readmission due to PONV (6.9% vs 11.1%, p=0.560) between the two groups. Prolonged LOS due to PONV occurred in 20.7% of SG patients and 19.4% of GB patients (p=0.901).
Conclusions: The effect of PONV is similar following SG and GB. Specifically, we found no significant differences in patient nausea scores or number of antiemetic rescue doses. Importantly, there was no difference in readmission or prolonged hospitalization due to PONV between SG and GB. While PONV is particularly important in bariatric patients as it is a major contributor to patient readmission, protocols and patient education on PONV do not need to be procedure specific.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77391
Program Number: P487
Presentation Session: Poster (Non CME)
Presentation Type: Poster