Impact of Emend on Perioperative Bariatric Surgery Antiemetic Utilization, Patient Satisfaction, and Costs

Abstract

Purpose: Postoperative nausea and vomiting (PONV) is one of the most common adverse effects of anesthesia and surgery, resulting in patient discomfort and dissatisfaction. Latest research has demonstrated the efficacy of NK-1 receptor antagonists in PONV management and its use in chemotherapy nausea prophylaxis. The authors of this article would like to provide evidence to support the use fosaprepitant, as monotherapy, in postoperative care, replacing a polypharmacological standard of care regimen.Methods: This was a retrospective chart review of 400 patients who received standard of care antiemetic regimen or received fosaprepitant (No-Fosaprepitant vs. Fosaprepitant groups, respectively). The primary outcome of this study is to evaluate the impact of fosaprepitant (administered intravenously) on perioperative antiemetic use, treatment cost, and patient satisfaction.Results: Total PONV medication cost decreased with the replacement of standard of care regimen for fosaprepitant, from 46.47 ± 20.54 United States Dollars in the no-Fosaprepitant group to 25.69 ± 14.84 United States Dollars in the Fosaprepitant group. There was a significant reduction in antiemetic doses between groups; 0.37 ± 0.745 versus 7.61 ± 5.202 for ondansetron (P = 0.001), 92 ± 1.279 versus 2.21 ± 2.399 for promethazine (P = 0.001), 0.25 ± 0.685 versus 1.41 ± 0.577 for scopolamine patch (P = 0.001), and 0.05 ± 0.218 versus 1.14 ± 0.398 for dexamethasone (P = 0.001). Patient satisfaction, measured by a questionnaire, was a 11.6% higher in the Fosaprepitant group. Conclusion:Fosaprepitant is a relevant alternative in preventing and treating PONV in patients who underwent bariatric/metabolic surgical procedures.