Spaniolas Konstantinos, Nie Lizhou, Moller Daryn, Tatarian Talar, Hesketh Anthony, Yang Jie, Docimo Salvatore, Bates Andrew, Gan Tong J, Pryor Aurora
Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11794, USA.
Department of Family, Population & Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11794, USA.
Obes Surg. 2020 Nov;30(11):4250-4257. doi: 10.1007/s11695-020-04795-8. Epub 2020 Jun 25.
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.
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.
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).
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.
袖状胃切除术（SG）后发生的术后恶心呕吐（PONV）很常见。在强化康复路径中，特定干预措施预防PONV的效果仍不明确。本研究的目的是评估预防PONV的综合方法对患者结局和医院资源利用的影响。
对接受SG的患者进行前瞻性随机试验。干预组术前接受阿瑞匹坦和透皮东莨菪碱，术中接受昂丹司琼和地塞米松，并采用全静脉麻醉。对照组接受吸入麻醉和两种术中使用的止吐药，未进行术前预防。主要终点是与PONV相关的出院延迟。
83例患者完成了研究（干预组41例，对照组42例）。89%的患者在术后第一天出院回家。对照组有4例患者出现与PONV相关的出院延迟，干预组无此情况（9.5%对0，p = 0.119）。在所有检查的住院时间点，干预组患者的PONV评分显著较低（言语评分p = 0.0392，Rhodes指数p < 0.0001），且在24小时时自我评定的恢复质量显著较高（恢复质量-15量表，p < 0.05）。
与对照组相比，采用多层面方法预防PONV可显著降低PONV的严重程度，并改善自我报告的恢复质量。在整个强化康复队列中，与PONV相关的再入院、急诊就诊和出院延迟并不常见。
