Preoperative reflux or regurgitation symptoms are independent predictors of postoperative nausea and vomiting (PONV) in patients undergoing bariatric surgery: a propensity score matching analysis

Jie Zhu; Lina Wu; Guoji Chen; Xin Zhao; Wenhui Chen; Zhiyong Dong; Xiaomei Chen; Songhao Hu; Xiaoying Xie; Cunchuan Wang; Huaxi Wang; Wah Yang; Chinese Obesity and Metabolic Surgery Collaborative

doi:10.1007/s11695-021-05859-z

Preoperative reflux or regurgitation symptoms are independent predictors of postoperative nausea and vomiting (PONV) in patients undergoing bariatric surgery: a propensity score matching analysis

Obes Surg. 2022 Mar;32(3):819-828. doi: 10.1007/s11695-021-05859-z. Epub 2022 Jan 28.

Authors

Jie Zhu^#^{1

2}, Lina Wu^#^{1

2}, Guoji Chen^{1

2}, Xin Zhao^{1

2}, Wenhui Chen^{1

2}, Zhiyong Dong^{1

2}, Xiaomei Chen^{1

2}, Songhao Hu^{1

2}, Xiaoying Xie³, Cunchuan Wang^{4

5}, Huaxi Wang^{6

7}, Wah Yang^{8

9}; Chinese Obesity and Metabolic Surgery Collaborative

Affiliations

¹ Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, China.
² Joint Institute of Metabolic Medicine Between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China.
³ Department of Rehabilitation, The Fifth People's Hospital of Yibin, No. 113 Jiaotong Street, Yibin, Sichuan Province, China.
⁴ Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, China. twcc@jnu.edu.cn.
⁵ Joint Institute of Metabolic Medicine Between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China. twcc@jnu.edu.cn.
⁶ Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, China. 1444546@qq.com.
⁷ Joint Institute of Metabolic Medicine Between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China. 1444546@qq.com.
⁸ Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, China. yangwah@qq.com.
⁹ Joint Institute of Metabolic Medicine Between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China. yangwah@qq.com.

^# Contributed equally.

PMID: 35088249
DOI: 10.1007/s11695-021-05859-z

Abstract

Background: Postoperative nausea and vomiting (PONV) is common side effect after gastrointestinal surgery. It causses discomfort, increase risk of incision disruption, bleeding and airway blockage. This study aimed to investigate the incidence and severity of PONV and determine whether preoperative reflux or regurgitation symptoms influence PONV in patients undergoing bariatric surgery.

Methods: Patients with obesity underwent laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in our center between January 2016 and December 2018 were divided into PONV and NoPONV group and analyzed retrospectively. PONV and postoperative pain visual analogue scale (VAS) were analyzed after surgery. A 1:1 propensity score matching (PSM) method was performed, and multivariable logistic regression analyses were used to identify predictors for PONV.

Results: There were 483 patients enrolled, with a mean age of 30.19 ± 9.96 years, and 134 pairs of matched patients were selected from PONV group and NoPONV group after PSM. PONV occurred in 288 (59.6%) patients after bariatric surgery (77.4% after LSG vs 21.5% after LRYGB, p < 0.001). In PONV group, 210 (72.9%) were female, preoperative reflux or regurgitation symptoms were 128 (33.6%). Multivariable analysis found that preoperative reflux or regurgitation symptoms were independent risk factors for PONV after LSG, with an OR of 2.78 (95% CI: 1.12-6.93, p = 0.028).

Conclusions: Incidence of PONV after bariatric surgery is high. For the first time, this study valued preoperative reflux or regurgitation symptoms as risk factors that may promote PONV after bariatric surgery. Patients with preoperative symptoms undergoing LSG have a higher risk of PONV, so these patients should be carefully evaluated for the feasibility of LSG before surgery.

Keywords: Bariatric surgery; Gastric bypass; Postoperative nausea and vomiting (PONV); Reflux or regurgitation; Sleeve gastrectomy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Bariatric Surgery* / adverse effects
Female
Gastrectomy / adverse effects
Gastrectomy / methods
Gastric Bypass* / methods
Gastroesophageal Reflux* / epidemiology
Humans
Laparoscopy* / adverse effects
Laparoscopy* / methods
Male
Obesity, Morbid* / surgery
Postoperative Complications / epidemiology
Postoperative Nausea and Vomiting / epidemiology
Postoperative Nausea and Vomiting / etiology
Propensity Score
Retrospective Studies
Young Adult