ABSTRACT
PURPOSE: Patients undergoing bariatric surgery are at particular high risk of postoperative nausea and vomiting (PONV). Few studies have shown the superiority of opioid-free anesthesia (OFA) over general anesthesia with opioids in bariatric surgery. The aim was to investigate the potential advantages of the OFA in bariatric surgery. MATERIALS AND METHODS: This is a retrospective study on a prospectively collected database that included bariatric patients over a 3-year period. All patients who underwent bariatric surgery at our institution were included and divided into opioid-free or standard anesthesia. The primary endpoint was the length of hospital stay. Data was collected and analyzed using a propensity score. RESULTS: We included 344 patients, of these 209 (60.8%) received opioid-free and 135 (39.2%) received a standard anesthesia. Mean age was 46.2 ± 11.2 years, 265 (77.0%) patients were female, and 238 (69.2%) had at least one associated medical problem. The two groups were similar in terms of age, gender, BMI, associated medical problems, and type of operations. Postoperatively, we observed no significant difference in opioid requirement, while significantly less doses of antiemetics were administered in the OFA group at postoperative day 1 (0.4 ± 0.7 vs. 0.7 ± 1.0 doses, p = 0.006) and 2 (0.1 ± 0.4 vs. 0.2 ± 0.6 doses, p = 0.022). Length of stay was significantly shorter in the OFA group (2.8 ± 0.9 vs. 3.5 ± 2.0 days, p < 0.001) both in the overall and in the propensity score-matched analyses. CONCLUSION: OFA is effective for patients undergoing bariatric surgery. Perioperative outcomes are similar, while OFA patients required less antiemetics and were discharged earlier from hospital.
Subject(s)
Antiemetics , Bariatric Surgery , Obesity, Morbid , Adult , Analgesics, Opioid/therapeutic use , Anesthesia, General , Antiemetics/therapeutic use , Bariatric Surgery/adverse effects , Female , Humans , Middle Aged , Obesity, Morbid/surgery , Pain, Postoperative/drug therapy , Propensity Score , Retrospective StudiesABSTRACT
BACKGROUND: It is known that functional recovery of the bowel is slower after right colectomy (RC) compared to left colectomy (LC), but very little has been reported on transverse colectomy (TC). OBJECTIVES: The aim of this study was to compare the clinical and early functional outcomes of TC, a more infrequent operation, to RC, and LC for colorectal cancer. METHODS: Between December 2011 and December 2017, all patients undergoing elective colon resection in our institution were treated according to a standardized ERAS protocol and entered in a prospective database. We included in the study patients undergoing laparoscopic TC, RC, or LC for cancer with curative intent. The primary endpoint was prolonged postoperative ileus (PPOI), defined as need to insert a nasogastric tube, or refractory nausea VAS > 4 on or after the third postoperative day. Secondary endpoints were postoperative morbidity and length of hospital stay (LoS). RESULTS: Out of 286 patients, 126 met the inclusion criteria: 20 underwent TC, 65 RC, and 41 LC. Patients in LC group were younger than in TC and RC groups; other baseline demographics were similar. PPOI was observed in 5 (25%), 26 (40%), and 10 (24%) patients in TC, RC, and LC groups, respectively (p = 0.417). In single group comparisons, the incidence of PPOI in the TC group was significantly lower in comparison to the RC group (OR for RC: 4.255, 95% CI 1.092-16.667, p = 0.037) and similar to the LC group. No significant differences in terms of postoperative complications or LoS stay were observed. CONCLUSION: The incidence of PPOI after segmental laparoscopic colectomy for cancer within an ERAS program appears as infrequent in TC as in LC and lower than after RC. It may be reasonable to consider a slower oral intake after RC, as it represents an independent predictor of PPOI.