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BALTIMORE -- Bariatric surgery patients with postoperative nausea had longer hospital stays and more upper endoscopies and visits to the emergency room, a retrospective single-institution chart review found.

Among nearly 450 patients who underwent laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass, those with documented nausea had a significantly greater length of stay compared to those without (2.4 vs 1.6 days, P<0.01), according to Sarah Suh, BS, of Medical College of Wisconsin in Milwaukee.

Patients with nausea in the study were also more likely to have an emergency department visit within 30 days of their surgery compared to those without nausea (17.5% vs 9.7%, P=0.02) and more likely to have an upper endoscopy (2.5% vs 0%, respectively, P=0.07), she reported here at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) annual meeting.

Compared with white patients, non-white patients had 1.8 times greater risk of having postoperative nausea (P=0.007), and patients who underwent sleeve gastrectomy had twice the risk of postoperative nausea than those who had Roux-en-Y (P=0.001).

Postoperative nausea and vomiting (PONV) can have a substantial effect on quality outcomes for bariatric surgery patients, Suh noted. This data "highlight the need for a metric to more accurately measure PONV, as well as a standardized antiemetic treatment pathway to improve quality outcomes," she said.

The current antiemetic protocol indicates that all patients preoperatively get transabdominal preperitoneal patch plasty, rectus sheath block, and a scopolamine patch. Patients with a significant history of anesthesia-related PONV also receive fosaprepitant (Emend), Suh highlighted.

Once in the operating room, all patients get a single dose of IV dexamethasone (Decadron) with anesthesia. As needed, patients are given prochlorperazine (Compazine), ondansetron hydrochloride (Zofran), and metoclopramide (Reglan), postoperatively.

"Most of our postoperative drugs are given to patients on an as-needed basis rather than being scheduled," Suh said. "We actually think that this would be a great first step as a quality intervention in order to minimize the instance of nausea by scheduling these drugs to maximize prophylaxis instead of giving these drugs as rescue medications once patients start to experience symptoms."

When it comes to clinical practice, future quality initiatives should focus on pre-op carbohydrate loading, and developing standardized regimens for intraoperative, preoperative, and postoperative antiemetic treatment, Suh emphasized.

Suh's group evaluated 449 adult bariatric surgery patients with (n=160) and without (n=289) documented postoperative nausea, defined as practitioner-noted nausea requiring antiemetic medication in the medical documents. Mean patient age in the nausea group was 41.1, and 35% were non-white. The group without nausea had a mean age of 44.8 and 23.2% were non-white. Most of the patients in the study were women (77.5%).

Among the documented nausea patients, 107 had sleeve gastrectomy and 53 had Roux-en-Y. These numbers were 145 and 144, respectively, for those without nausea.

Univariate analyses were done to determine the effect of postoperative nausea on patients' readmissions, reoperations, length of stay, and overall complications. Limitations of the study included that the data were derived from a single institution, and that the nature of the nausea was subjective, and lacked a standardized nausea scale scoring system.

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