Analysis of risk factors of severe postoperative nausea and vomiting after laparoscopic bariatric surgery
Objective To analyze the clinical data of obese patients undergoing laparoscopic bariatric surgery and to explore the risk factors of severe postoperative nausea and vomiting(PONV).Methods Totally 471 obese patients underwent laparoscopic bariatric surgery in Beijing Friendship Hospital Affiliated to Capital Medical University from January to December 2021.Troisetron was applied in surgery to prevent PONV,and dexamethasone and ondansetron were applied after surgery to prevent PONV.According to whether postoperative rescuing antiemetics administration was needed,471 patients were divided into no-severe PONV group(n=387)and severe PONV group(n=84).The gender,age,body mass index,smoking habits,comorbidities,anesthesia methods,anesthesia induction drugs,anesthesia time,surgery lasting time,surgery types,indwelling abdominal drainage tubes or not,intraoperative antiemetic types,intraoperative total liquid infusion volume,intraoperative sufentanil dosages,postoperative sufentanil and dexmedetomidine dosages,and postoperative rescuing antiemetics were compared between two groups.Multivariate logistic regression analysis was done to assess the influencing factors of severe PONV after laparoscopic bariatric surgery.Results The incidence of severe PONV in 471 patients was 17.8％.In 84 patients with severe PONV,PONV developed within 24 h after surgery in 54 patients and 24 h after surgery in 30.The rescuing antiemetic therapy used metoclopramide in 56 patients,ondansetron in 14,dexamethasone in 2,metoclopramide+ondansetron in 10,and metoclopramide+ondansetron+dexamethasone in 2.The rescuing antiemetics were used once in 64 patients,twice in 13,three times in 5,4 times in 1,and 5 times in 1.The proportions of females,laparoscopic sleeve gastrectomy,abdominal drainage tube indwelling,and postoperative rescuing analgesia were higher in severe PONV group(85.7％,88.1％,84.5％,41.7％)than those in no-severe PONV group(64.1％,70.3％,72.1％,17.3％)(P＜0.05).The patients were younger in severe PONV group[32.0(27.0,36.0)years]than in no-severe PONV group[34.0(29.0,39.0)years](Z=-2.381,P=0.017).The intraoperative total liquid infusion volume was smaller in severe PONV group[900.0(762.5,1 100.0)mL]than that in no-severe PONV group[920.0(800.0,1 150.0)mL](Z=-2.228,P=0.026).The length of anesthesia and surgery lasting time were significantly shorter in severe PONV group[96.5(80.0,126.5),80.0(63.5,103.8)min]than those in no-severe PONV group[110.0(92.0,140.0),93.0(70.0,120.0)min](Z=-3.335,P=0.001;Z=-3.399,P=0.001).There were no significant differences in the body mass index,smoking habits,comorbidities,anesthesia methods,use of etomidate for anesthesia induction,intraoperative antiemetic types,intraoperative sufentanil dosages,postoperative sufentanil and dexmedetomidine dosages,and use of pethidine for rescuing analgesia between two groups(P＞0.05).Female(OR=2.928,95％CI:1.478-5.797,P=0.002),reflux esophagitis(OR=2.443,95％CI:1.370-4.365,P=0.002),laparoscopic sleeve gastrectomy(OR=2.746,95％CI:1.330-5.671,P=0.006),abdominal drainage tube indwelling(OR=2.252,95％CI:1.149-4.416,P=0.018),and postoperative rescuing analgesia(OR=3.407,95％CI:1.988-5.840,P＜0.001)were the independent risk factors of severe PONV.Conclusion In obese patients undergoing laparoscopic bariatric surgery,the factors as females,reflux esophagitis,laparoscopic sleeve gastrectomy,abdominal drainage tube indwelling,and postoperative rescuing analgesia increase the risk of severe PONV.
obesitylaparoscopic bariatric surgerypostoperative nausea and vomitingreflux esophagitislaparoscopic sleeve gastrectomy
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