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Prediction of postoperative nausea and vomiting by point-of-care gastric ultrasound: can we improve complications and length of stay in emergency surgery? A cohort study.

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Title: Prediction of postoperative nausea and vomiting by point-of-care gastric ultrasound: can we improve complications and length of stay in emergency surgery? A cohort study.
Authors: Cozza, Valerio1, Barberis, Lorenzo2, Altieri, Gaia2, Donatelli, Mario2, Sganga, Gabriele3 gabriele.sganga@policlinicogemelli.it, La Greca, Antonio3
Source: BMC Anesthesiology. 8/31/2021, Vol. 21 Issue 1, p1-10. 10p.
Subject Terms: *ABDOMINAL surgery, *STOMACH, *LENGTH of stay in hospitals, *PERIOPERATIVE care, *GASTROINTESTINAL motility, *ULTRASONIC imaging, *POINT-of-care testing, *PREOPERATIVE period, *ANTHROPOMETRY, *CONVALESCENCE, *SURGERY, *PATIENTS, *RISK assessment, *PRE-tests & post-tests, *EMERGENCY medical services, *QUALITY assurance, *CRITICAL care medicine, *POSTOPERATIVE period, *DESCRIPTIVE statistics, *DUMPING syndrome, *ADVERSE health care events, *LONGITUDINAL method, *DISEASE risk factors, PREVENTION of surgical complications, DIGESTIVE organ surgery
Abstract: Background: Postoperative nausea and vomiting and postoperative ileus are common after major digestive surgery and represent one of the significant problems in Acute Care Surgery. The delivery model of emergency surgery needs to be improved in order to foster a patient-centered care. The multimodal approach suggested by Enhanced Recovery After Surgery (ERAS®) Guidelines is gaining widespread acceptance but is difficult to apply to emergency surgery. Ultrasound examination of the gastric antrum allows a reliable assessment of gastric contents and volume and might help contribute to improve perioperative care in the emergency setting. Methods: Gastric ultrasound examinations were performed preoperatively and postoperatively on forty-one patients undergoing emergency abdominal surgery. Gastric cross-sectional area (CSA) was measured, in order to estimate the gastric volume. The data obtained were used to evaluate a possible relationship between delayed gastric emptying and postoperative adverse event. Results: Gastric antrum detection rate varied from 31.8% in open up to 78.9% in laparoscopic surgeries (p = 0.003). Six patients experienced adverse outcomes, had an antiemetic therapy administered and/or a nasogastric tube inserted. Mean CSA was significantly higher in this group (12.95 cm2 vs 6.12 cm2; p = 0.040). Conclusions: Sensitivity of gastric ultrasound varies depending on surgical technique. A dilated gastric antrum is significantly related to postoperative adverse outcomes and a careful ultrasound follow-up might help tailor postoperative nutrition and antiemetic therapy. In patients who experienced adverse events, antral CSA showed an average increase of more than 50% over a period of 72 h after surgery. A relative measure could be used to predict the risk of postoperative ileus. Overall, gastric ultrasound seems to be a promising diagnostic tool and a useful way to integrate ERAS® protocol in emergency abdominal surgery. [ABSTRACT FROM AUTHOR]
Copyright of BMC Anesthesiology is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Prediction of postoperative nausea and vomiting by point-of-care gastric ultrasound: can we improve complications and length of stay in emergency surgery? A cohort study.
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  Data: <searchLink fieldCode="JN" term="%22BMC+Anesthesiology%22">BMC Anesthesiology</searchLink>. 8/31/2021, Vol. 21 Issue 1, p1-10. 10p.
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  Data: *<searchLink fieldCode="DE" term="%22ABDOMINAL+surgery%22">ABDOMINAL surgery</searchLink><br />*<searchLink fieldCode="DE" term="%22STOMACH%22">STOMACH</searchLink><br />*<searchLink fieldCode="DE" term="%22LENGTH+of+stay+in+hospitals%22">LENGTH of stay in hospitals</searchLink><br />*<searchLink fieldCode="DE" term="%22PERIOPERATIVE+care%22">PERIOPERATIVE care</searchLink><br />*<searchLink fieldCode="DE" term="%22GASTROINTESTINAL+motility%22">GASTROINTESTINAL motility</searchLink><br />*<searchLink fieldCode="DE" term="%22ULTRASONIC+imaging%22">ULTRASONIC imaging</searchLink><br />*<searchLink fieldCode="DE" term="%22POINT-of-care+testing%22">POINT-of-care testing</searchLink><br />*<searchLink fieldCode="DE" term="%22PREOPERATIVE+period%22">PREOPERATIVE period</searchLink><br />*<searchLink fieldCode="DE" term="%22ANTHROPOMETRY%22">ANTHROPOMETRY</searchLink><br />*<searchLink fieldCode="DE" term="%22CONVALESCENCE%22">CONVALESCENCE</searchLink><br />*<searchLink fieldCode="DE" term="%22SURGERY%22">SURGERY</searchLink><br />*<searchLink fieldCode="DE" term="%22PATIENTS%22">PATIENTS</searchLink><br />*<searchLink fieldCode="DE" term="%22RISK+assessment%22">RISK assessment</searchLink><br />*<searchLink fieldCode="DE" term="%22PRE-tests+%26+post-tests%22">PRE-tests & post-tests</searchLink><br />*<searchLink fieldCode="DE" term="%22EMERGENCY+medical+services%22">EMERGENCY medical services</searchLink><br />*<searchLink fieldCode="DE" term="%22QUALITY+assurance%22">QUALITY assurance</searchLink><br />*<searchLink fieldCode="DE" term="%22CRITICAL+care+medicine%22">CRITICAL care medicine</searchLink><br />*<searchLink fieldCode="DE" term="%22POSTOPERATIVE+period%22">POSTOPERATIVE period</searchLink><br />*<searchLink fieldCode="DE" term="%22DESCRIPTIVE+statistics%22">DESCRIPTIVE statistics</searchLink><br />*<searchLink fieldCode="DE" term="%22DUMPING+syndrome%22">DUMPING syndrome</searchLink><br />*<searchLink fieldCode="DE" term="%22ADVERSE+health+care+events%22">ADVERSE health care events</searchLink><br />*<searchLink fieldCode="DE" term="%22LONGITUDINAL+method%22">LONGITUDINAL method</searchLink><br />*<searchLink fieldCode="DE" term="%22DISEASE+risk+factors%22">DISEASE risk factors</searchLink><br /><searchLink fieldCode="DE" term="%22PREVENTION+of+surgical+complications%22">PREVENTION of surgical complications</searchLink><br /><searchLink fieldCode="DE" term="%22DIGESTIVE+organ+surgery%22">DIGESTIVE organ surgery</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Postoperative nausea and vomiting and postoperative ileus are common after major digestive surgery and represent one of the significant problems in Acute Care Surgery. The delivery model of emergency surgery needs to be improved in order to foster a patient-centered care. The multimodal approach suggested by Enhanced Recovery After Surgery (ERAS®) Guidelines is gaining widespread acceptance but is difficult to apply to emergency surgery. Ultrasound examination of the gastric antrum allows a reliable assessment of gastric contents and volume and might help contribute to improve perioperative care in the emergency setting. Methods: Gastric ultrasound examinations were performed preoperatively and postoperatively on forty-one patients undergoing emergency abdominal surgery. Gastric cross-sectional area (CSA) was measured, in order to estimate the gastric volume. The data obtained were used to evaluate a possible relationship between delayed gastric emptying and postoperative adverse event. Results: Gastric antrum detection rate varied from 31.8% in open up to 78.9% in laparoscopic surgeries (p = 0.003). Six patients experienced adverse outcomes, had an antiemetic therapy administered and/or a nasogastric tube inserted. Mean CSA was significantly higher in this group (12.95 cm2 vs 6.12 cm2; p = 0.040). Conclusions: Sensitivity of gastric ultrasound varies depending on surgical technique. A dilated gastric antrum is significantly related to postoperative adverse outcomes and a careful ultrasound follow-up might help tailor postoperative nutrition and antiemetic therapy. In patients who experienced adverse events, antral CSA showed an average increase of more than 50% over a period of 72 h after surgery. A relative measure could be used to predict the risk of postoperative ileus. Overall, gastric ultrasound seems to be a promising diagnostic tool and a useful way to integrate ERAS® protocol in emergency abdominal surgery. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
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  Data: <i>Copyright of BMC Anesthesiology is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1186/s12871-021-01428-0
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        Text: English
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      – SubjectFull: ABDOMINAL surgery
        Type: general
      – SubjectFull: STOMACH
        Type: general
      – SubjectFull: LENGTH of stay in hospitals
        Type: general
      – SubjectFull: PERIOPERATIVE care
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      – SubjectFull: GASTROINTESTINAL motility
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      – SubjectFull: ULTRASONIC imaging
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      – SubjectFull: POINT-of-care testing
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