Perioperative predictors of prolonged hospital stay and postoperative nausea and vomiting after metabolic bariatric surgery

BACKGROUND: Prolonged length of stay (LOS) and postoperative nausea and vomiting (PONV) are frequent after metabolic bariatric surgery (MBS) and negatively affect recovery. This study aimed to identify predictors of prolonged LOS and PONV in patients undergoing MBS. METHODS: A retrospective cohort of 476 patients undergoing MBS, including laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB), between January 2022 and September 2023 was analyzed. Patient characteristics and perioperative variables were reviewed. Prolonged hospitalization was defined as LOS > 3 days. Multivariable logistic regression modeling was used to identify independent predictors of prolonged LOS. RESULTS: Among 476 patients, the median LOS was 3 days, and 23.1% required hospitalization > 3 days. Multivariable analysis identified longer anesthesia duration (odds ratio [OR]: 3.05, 95% confidence interval [CI]: 1.70-5.50, p < 0.001), greater intraoperative fluid rate (OR: 1.41, 95% CI: 1.11-1.78, p = 0.005), asthma (OR: 2.99, 95% CI: 1.09-8.18, p = 0.033), and PONV (OR: 2.09, 95% CI: 1.29-3.40, p = 0.003) as independent predictors of prolonged hospitalization. These associations remained significant after adjustment for baseline covariates. The type of surgery (LRYGB vs. LAGB) was not an independent predictor of prolonged LOS in the multivariable model (OR: 1.65, 95% CI 0.94-2.87, p = 0.079). PONV occurred in 45.6% of patients and was more common in females and younger patients (p < 0.001). CONCLUSION: Prolonged anesthesia duration, greater intraoperative fluid rate, asthma, and PONV independently predicted extended hospital stay after MBS. Optimizing anesthesia time, fluid therapy, procedure-specific management, and respiratory management may enhance recovery and shorten hospitalization.