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Postoperative nausea and vomiting after laparoscopic sleeve gastrectomy: a secondary analysis based on WHO obesity classification

anesthesiology-and-pain-management
gastroenterology
surgery

Abstract

Background Postoperative nausea and vomiting (PONV) is a frequent complication following laparoscopic sleeve gastrectomy (LSG). While prior studies using simplified body mass index (BMI) categorizations largely show no significant association, an initial observation in our prospective cohort suggested an 8% higher PONV incidence in Class I obesity. This prompted a formal analysis using detailed WHO classification to investigate this potential association while controlling for confounders.

Methods This secondary analysis of a prospective cohort included 1054 adults undergoing LSG. Preoperative BMI was classified according to WHO criteria. PONV, defined as an Index of Nausea, Vomiting, and Retching (INVR) score >0 within 72 hours postoperatively, was the primary outcome. The association was assessed using logistic regression across four models: an unadjusted model (Model 1) and three multivariable models adjusting for demographics, Apfel score, and perioperative management variables (Models 2-4).

Results The overall incidence of PONV was 76.3%. In the unadjusted model (Model 1), Class I obesity was associated with higher odds of PONV compared to Class III obesity (OR 1.65, 95% CI 1.11–2.45, P=0.013). This association was not significant in any of the adjusted models (Models 2-4, all P >0.05). No other BMI categories were significantly associated with PONV risk in the multivariable analyses.

Conclusions After adjusting for key patient and perioperative factors, preoperative BMI classified by WHO criteria was not an independent risk factor for PONV after LSG. This suggests that the initially observed difference may be attributable to confounding factors effectively mitigated by standardized perioperative management.

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