A Comprehensive Approach for the Prevention of Nausea and Vomiting Following Sleeve Gastrectomy: a Randomized Controlled Trial

Konstantinos Spaniolas; Lizhou Nie; Daryn Moller; Talar Tatarian; Anthony Hesketh; Jie Yang; Salvatore Docimo; Andrew Bates; Tong J. Gan; Aurora Pryor

doi:10.1007/s11695-020-04795-8

A Comprehensive Approach for the Prevention of Nausea and Vomiting Following Sleeve Gastrectomy: a Randomized Controlled Trial

Konstantinos Spaniolas, Lizhou Nie, Daryn Moller, Talar Tatarian, Anthony Hesketh, Jie Yang, Salvatore Docimo, Andrew Bates, Tong J. Gan, Aurora Pryor

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

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.

Original language	English (US)
Pages (from-to)	4250-4257
Number of pages	8
Journal	Obesity Surgery
Volume	30
Issue number	11
DOIs	https://doi.org/10.1007/s11695-020-04795-8
State	Published - Nov 1 2020
Externally published	Yes

Keywords

Enhanced recovery
Nausea
PONV
Sleeve gastrectomy

ASJC Scopus subject areas

Surgery
Endocrinology, Diabetes and Metabolism
Nutrition and Dietetics

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10.1007/s11695-020-04795-8

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title = "A Comprehensive Approach for the Prevention of Nausea and Vomiting Following Sleeve Gastrectomy: a Randomized Controlled Trial",

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 = "Enhanced recovery, Nausea, PONV, Sleeve gastrectomy",

author = "Konstantinos Spaniolas and Lizhou Nie and Daryn Moller and Talar Tatarian and Anthony Hesketh and Jie Yang and Salvatore Docimo and Andrew Bates and Gan, {Tong J.} and Aurora Pryor",

note = "Funding Information: This study was funded in part by a peer-reviewed grant by the Society for the Surgery of the Alimentary Tract Foundation (Spaniolas). Funding Information: Ms. Nie and Drs. Moller, Tatarian, Hesketh, Yang, and Bates have nothing to disclose. Dr. Gan reports personal fees from Merck, Mallinckrodt, Edwards, Acacia, and Medtronic, outside the submitted work. Dr. Docimo reports personal fees from Boston Scientific, outside the submitted work. Dr. Spaniolas reports grants from SSAT Foundation, during the conduct of the study, grants from Merck, and personal fees from Biom{\textquoteright}up and Gore, outside the submitted work. Dr. Pryor reports grants from Baranova and Obalon and personal fees from Merck, Medtronic, Gore, Ethicon, and Stryker, outside the submitted work. Publisher Copyright: {\textcopyright} 2020, Springer Science+Business Media, LLC, part of Springer Nature.",

year = "2020",

month = nov,

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doi = "10.1007/s11695-020-04795-8",

language = "English (US)",

volume = "30",

pages = "4250--4257",

journal = "Obesity Surgery",

issn = "0960-8923",

publisher = "Springer New York",

number = "11",

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T1 - A Comprehensive Approach for the Prevention of Nausea and Vomiting Following Sleeve Gastrectomy

T2 - a Randomized Controlled Trial

AU - Spaniolas, Konstantinos

AU - Nie, Lizhou

AU - Moller, Daryn

AU - Tatarian, Talar

AU - Hesketh, Anthony

AU - Yang, Jie

AU - Docimo, Salvatore

AU - Bates, Andrew

AU - Gan, Tong J.

AU - Pryor, Aurora

N1 - Funding Information: This study was funded in part by a peer-reviewed grant by the Society for the Surgery of the Alimentary Tract Foundation (Spaniolas). Funding Information: Ms. Nie and Drs. Moller, Tatarian, Hesketh, Yang, and Bates have nothing to disclose. Dr. Gan reports personal fees from Merck, Mallinckrodt, Edwards, Acacia, and Medtronic, outside the submitted work. Dr. Docimo reports personal fees from Boston Scientific, outside the submitted work. Dr. Spaniolas reports grants from SSAT Foundation, during the conduct of the study, grants from Merck, and personal fees from Biom’up and Gore, outside the submitted work. Dr. Pryor reports grants from Baranova and Obalon and personal fees from Merck, Medtronic, Gore, Ethicon, and Stryker, outside the submitted work. Publisher Copyright: © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

PY - 2020/11/1

Y1 - 2020/11/1

N2 - 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.

AB - 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.

KW - Enhanced recovery

KW - Nausea

KW - PONV

KW - Sleeve gastrectomy

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JF - Obesity Surgery

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ER -

A Comprehensive Approach for the Prevention of Nausea and Vomiting Following Sleeve Gastrectomy: a Randomized Controlled Trial

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