Evidence map›Paper›PMID 41925808›Full record

ArticleObesity surgery2026

A Pain-informed Predictive Model and Mediation Analysis for Postoperative Nausea after Metabolic Bariatric Surgery: Insights from the PAIN OUT Registry.

Hongxu Xu, Pengchi Zhang, Xiahao Ding, Siyang Xu, Li Yin, Yanning Qian, Bo Gui

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Article in Obesity surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

7 authors.

Hongxu XuDepartment of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
Pengchi ZhangDepartment of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
Xiahao DingDepartment of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
Siyang XuDepartment of Anesthesiology and Pain Medicine, Geriatric Hospital of Nanjing Medical University, Nanjing, China.
Li YinDepartment of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
Yanning QianDepartment of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
Bo GuiDepartment of Anesthesiology and Pain Medicine, Geriatric Hospital of Nanjing Medical University, Nanjing, China. guibosy@njmu.edu.cn.

Funding

Research Incubation Startup Fund of Jiangsu Province Geriatric Hospital FHQD202501Talent Construction Fund Research Project of Jiangsu Province Geriatric Hospital IR2021101
6 · The paper itself

Abstract

backgroundA validated prediction model and mediation analysis for postoperative nausea (PON) are essential to guide targeted prevention and treatment in metabolic bariatric surgery.

methodsThis study analyzed 2,331 anonymized metabolic bariatric surgery cases from the PAIN OUT database. PON was assessed on the first postoperative day using a standardized questionnaire. Clinically significant PON was defined as a numeric rating scale ≥ 4, categorizing participants into PONCS (scores 4–10) and Control (scores 0–3) groups.

resultsA total of 1,486 patients (63.7%) were assigned to the Control group and 845 (36.3%) to the PONCS group. Among 30 candidate predictors, the following were identified as independent predictive factors for PON: age (OR [95% CI]: 0.979 [0.970–0.987]), female gender (2.159 [1.738–2.682]), hypertension (0.785 [0.635–0.972]), diabetes (0.572 [0.420–0.779]), cancer (0.474 [0.259–0.869]), affective disorders (0.616 [0.497–0.763]), chronic pain (1.272 [1.011–1.600]), preoperative non-opioids (0.619 [0.430–0.890]), sleeve gastrectomy (1.710 [1.389–2.106]), and three postoperative interventions administered in the PACU—non-opioids (1.482 [1.183–1.855]), opioids (1.536 [1.219–1.936]), and regional nerve blocks (0.413 [0.274–0.622]). The model showed good discrimination (AUC = 0.709; 95% CI 0.687–0.730) and calibration. Internal validation yielded an optimism-corrected AUC of 0.708 (95% CI 0.687–0.730) and a calibration slope of 0.955. PACU-administered non-opioids, opioids, and regional nerve blocks mediated the effects of preoperative non-opioids use and chronic pain on the PON development.

conclusionThe novel PON prediction model shows favorable performance in metabolic bariatric surgery patients, with PACU-administered non-opioids, opioids, and regional nerve blocks identified as modifiable mediators linking preoperative non-opioids use and chronic pain to PON development.

Indexed as

Bariatric SurgeryObesity, MorbidPostoperative Nausea and VomitingPostoperative PainAdultFemaleHumansMaleMiddle AgedPain MeasurementPrediction AlgorithmsRegistriesRisk FactorsMediation effectMetabolic bariatric surgeryPatient-reported outcomesPostoperative nauseaPredictive model

Identifiers

PMID41925808

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