Comparison of aprepitant 80 mg oral, aprepitant 32.4 mg intravenous, and fosaprepitant 75 mg intravenous in the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy, a retrospective cohort study.

BACKGROUND: The most common postoperative (post-op) complication in bariatric surgery is postoperative nausea and vomiting (PONV) with up to 70% of patients reporting symptoms. PONV is also associated with longer post-anesthesia care unit (PACU) time and hospital stays overall. Aprepitant has shown efficacy in reducing PONV and has been added to many standard antiemetic regimens; however, the bioavailability of the oral formulation is not ideal in bariatric surgery patients, and the ideal dose intravenously (IV) has not been established. METHODS: This retrospective cohort study compared aprepitant 80 mg orally (PO) to aprepitant 32.4 mg intravenous (IV) and fosaprepitant 75 mg IV. The presence of PONV was defined by the number of doses of antiemetics administered postoperatively within four windows: PACU plus 1 h, defined as time upon entry to PACU+1 h, PACU + 12 h, PACU + 24 h, and any further doses administered while admitted thereafter. Secondary outcomes included time to diet ordered, length of hospital stay, and pain control. RESULTS: There was no difference in PONV between aprepitant 80 mg PO vs. 32.4 mg IV vs. fosaprepitant 75 mg in the immediate interim after surgery (PACU + 1 h); however, fosaprepitant was statistically superior to the other two groups at PACU + 12 h, PACU + 24 h, and total doses administered throughout admission. There was no difference in time to diet ordered or pain control, but fosaprepitant was superior when looking at length of stay. CONCLUSION: In this retrospective cohort, fosaprepitant 75 mg IV was found to be superior overall to aprepitant 32.4 mg IV and 80 mg PO.