Effect of perioperative restrictive and liberal fluid regimens on postoperative nausea-vomiting and quality of recovery in laparoscopic cholecystectomy

Table 1 Demographic data, mean ± SD

Variable	Group L3, n = 79	Group R4, n = 78	P value
Age, years	50.6 ± 9.9	51.3 ± 12.2	0.6901
Weight, kg	77.2 ± 13.0	78.3 ± 12.4	0.5921
Height, cm	165.3 ± 9.2	165.1 ± 8.0	0.8851
BMI, kg/m2	28.2 ± 3.8	28.9 ± 3.8	0.2551
Sex, male/female	22/57	20/58	0.7552
ASA, I/II/III	28/45/6	25/45/8	0.7992
Duration of surgery, minutes	40.5 ± 8.4	41.5 ± 5.2	0.3701
Duration of anesthesia in minutes	54.6 ± 8.9	55.4 ± 6.1	0.4981

¹Student’s t-test.

²χ² test.

³Liberal fluid treatment group.

⁴Restrictive fluid treatment group.

ASA: American Society of Anesthesiologists; BMI: Body mass index.

Table 2 Comparison of postoperative data between the research groups

Variable	Group L4, n = 79	Group R5, n = 78	Relative risk or mean difference (95%CI)	P value
Incidence of PONV, n (%)	30 (38.0)	55 (70.5)	0.54 (0.39-0.74)	< 0.0011
Time to first rescue anti-emetic, hours	3.93 ± 2.44	5.49 ± 4.32	1.55 (-0.14 to 3.26)	0.0372
Time to demand oral fluids, minutes	225.1 ± 94.4	164.4 ± 82.5	-60.7 (-88.6 to 32.7)	< 0.0012
Requirement of rescue analgesia, n (%)	53 (67.1%)	57 (73.1%)	0.91 (0.74-1.12)	0.4131
Time to first rescue analgesia, hours	2.94 ± 1.78	2.98 ± 2.59	0.039 (-0.81 to 0.88)	0.9272
Total tramadol consumption, mg	50 (50-100) (68.8 ± 28.1)	50 (50-50) (59.6 ± 19.9)	-9.21 (-18.3 to -0.06)	0.0693
First mobilization time, hours	2.91 ± 1.42	3.27 ± 1.46	0.35 (-0.09 to 0.81)	0.1232
Time to first oral solid food intake, hours	6.68 ± 0.91	6.78 ± 1.21	0.099 (-0.24 to 0.43)	0.5662

¹χ² test: Data are presented as n (%) with relative risk and 95% confidence interval.

²Student’s t-test: Data are presented as mean ± SD with mean difference and 95% confidence interval.

³Mann-Whitney U test: Data are presented as median (quartile 1, quartile 3) and (mean ± SD) with mean difference and 95% confidence interval.

⁴Group L: Liberal fluid treatment group.

⁵Group R: Restrictive fluid treatment group.

PONV: Postoperative nausea-vomiting.

Table 3 Comparison of Numerical Rating Scale scores between the study groups

Variables1	Group L2, n = 79	Group R3, n = 78	P value
15 minutes	1 (1.0-2.0) (1.4 ± 1)	1 (1.0-2.0) (1.2 ± 0.7)	0.342
30 minutes	2 (1.0-3.0) (2.1 ± 1.2)	2 (1.0-3.0) (2.0 ± 0.8)	0.844
60 minutes	2 (2.0-3.0) (2.4 ± 1.1)	2 (2.0-3.0) (2.6 ± 1.2)	0.247
2 hours	2 (2.0-4.0) (2.9 ± 1.3)	3 (2.0-4.0) (3.2 ± 1.3)	0.061
6 hours	2 (2.0-3.0) (2.7 ± 1.2)	2 (2.0-3.0) (2.5 ± 0.8)	0.676
12 hours	2 (2.0-3.0) (2.3 ± 0.8)	2 (2.0-2.3) (2.2 ± 0.9)	0.448
24 hours	2 (2.0-2.0) (2.0 ± 0.8)	2 (2.0-2.0) (2.0 ± 0.5)	0.592

¹Data are presented as median (quartile 1, quartile 3) and mean ± SD and analyzed with the Mann-Whitney U test.

²Group L: Liberal fluid treatment group.

³Group R: Restrictive fluid treatment group.

Table 4 Comparison of postoperative quality of recovery-15 scores between research groups

Factor1	Group L3, n = 79, median (Q1, Q3)	Group R4, n = 78, median (Q1, Q3)	Median difference	P value
Able to breathe easy	10 (9.0-10.0)	10 (9.0-10.0)	0	0.143
Able to enjoy food	10 (10.0-10.0)	10 (9.0-10.0)	0	0.097
Feeling rested	9 (9.0-10.0) (9.09 ± 0.91)	9 (8.0-10.0) (8.58 ± 1.31)	0	0.0222
Had good sleep	9 (8.0-10.0)	9 (8.0-10.0)	0	0.053
Able to look after personal toilet and hygiene unaided	10 (9.0-10.0)	10 (9.0-10.0)	0	0.735
Able to communicate with family or friends	10 (10.0-10.0)	10 (10.0-10.0)	0	0.747
Getting support from hospital doctors and nurses	10 (10.0-10.0)	10 (10.0-10.0)	0	0.990
Able to return to work or usual home activities	6 (6.0-7.0) (6.32 ± 1.23)	6 (5.0-7.0) (5.77 ± 1.63)	0	0.0232
Feeling comfortable and in control	9 (9.0-10.0) (9.22 ± 0.73)	9 (9.0-9.3) (8.81 ± 1.31)	0	0.0472
Having a feeling of general well-being	10 (9.0-10.0)	9 (9.0-10.0)	1	0.115
Moderate pain	7 (7.0-8.0)	7 (7.0-8.0)	0	0.760
Severe pain	9 (9.0-10.0)	9 (9.0-10.0)	0	0.843
Nausea or vomiting	10 (8.0-10.0) (9.15 ± 1.00)	8 (7.0-9.0) (8.12 ± 1.15)	2	< 0.0012
Feeling worried or anxious	10 (10.0-10.0)	10 (10.0-10.0)	0	0.655
Feeling sad or depressed	10 (10.0-10.0)	10 (10.0-10.0)	0	0.758
QoR-15 total score	137 (135.0-141.0) (137.20 ± 4.88)	135 (130.0-139.3) (134.00 ± 6.89)	2	0.0062

¹Data are presented as median (quartile 1, quartile 3) and analyzed by the Mann-Whitney U test.

²For comparisons with significant differences, mean ± SD was also presented.

³Group L: Liberal fluid treatment group.

⁴Group R: Restrictive fluid treatment group.

QoR-15: Quality of recovery-15.

Table 5 Univariate and multivariate analyses using logistic regression for the composite outcome of postoperative nausea and vomiting

Independent variable	Univariate		Multivariate
	P value	OR (95%CI)	P value	OR (95%CI)
Age, years	0.607	0.993 (0.965-1.021)	NA	NA
BMI, kg/m2	0.092	0.929 (0.854-1.012)	NA	NA
Female1	< 0.001	4.345 (2.013-9.381)	0.001	4.421 (1.862-10.490)
Restrictive group2	< 0.001	3.906 (2.007-7.601)	< 0.001	4.874 (2.294-10.350)
Time to demand oral fluids, minutes	0.983	1.000 (0.997-1.003)	NA	NA
First mobilization time in, hours	0.412	1.096 (0.880-1.365)	NA	NA
Total tramadol consumption, mg	0.320	1.009 (0.991-1.027)	NA	NA
Time to first oral solid food intake, hours	0.001	1.876 (1.283-2.744)	0.004	1.894 (1.230-2.919)
Duration of surgery, minutes	0.229	1.029 (0.982-1.077)	NA	NA
Duration of anesthesia, minutes	0.327	1.021 (0.979-1.065)	NA	NA

¹Reference sex is male.

²Reference group is liberal fluid treatment group.

BMI: Body mass index; CI: Confidence interval; NA: Not available; OR: Odds ratio.