Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2021; 9(35): 10861-10870
Published online Dec 16, 2021. doi: 10.12998/wjcc.v9.i35.10861
Identification of independent risk factors for intraoperative gastroesophageal reflux in adult patients undergoing general anesthesia
Xiao Zhao, Shi-Tong Li, Lian-Hua Chen, Kun Liu, Ming Lian, Hui-Juan Wang, Yi-Jiao Fang
Xiao Zhao, Shi-Tong Li, Lian-Hua Chen, Kun Liu, Ming Lian, Hui-Juan Wang, Anesthesiology Department, Shanghai General Hospital of Nanjing Medical University, Shanghai 200000, China
Yi-Jiao Fang, Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Yi-Jiao Fang, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
Author contributions: Zhao X and Wang HJ conceived and coordinated the study, designed, performed, and analyzed the experiments, and wrote the paper; Liu K, Wang HJ, Liu K, Li ST, Chen LH, and Fang YJ carried out the data collection and data analysis and revised the paper. All authors reviewed the results and approved the final version of the manuscript.
Institutional review board statement: This study was approved by the ethics committee of Shanghai General Hospital (2019KY037).
Informed consent statement: Informed consent was waived by the committee because of the retrospective nature of the study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The data set supporting the results of this article are included within the article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shi-Tong Li, MD, Academic Fellow, Anesthesiology Department, Shanghai General Hospital of Nanjing Medical University, No. 100 Haining Road, Hongkou District, Shanghai 200000, China. lishitongs021@163.com
Received: May 22, 2021
Peer-review started: May 22, 2021
First decision: June 28, 2021
Revised: July 25, 2021
Accepted: September 16, 2021
Article in press: September 16, 2021
Published online: December 16, 2021
Processing time: 201 Days and 21.3 Hours
Abstract
BACKGROUND

Gastroesophageal reflux (GER) affects up to 20% of the adult population and is defined as troublesome and frequent symptoms of heartburn or regurgitation. GER produces significantly harmful impacts on quality of life and precipitates poor mental well-being. However, the potential risk factors for the incidence and extent of GER in adults undergoing general anesthesia remain unclear.

AIM

To explore independent risk factors for the incidence and extent of GER during general anesthesia induction.

METHODS

A retrospective study was conducted, and 601 adult patients received general anesthesia intubation or laryngeal mask surgery between July 2016 and January 2019 in Shanghai General Hospital of Nanjing Medical University. This study recruited a total of 601 adult patients undergoing general anesthesia, and the characteristics of patients and the incidence or extent of GER were recorded. The potential risk factors for the incidence of GER were explored using multivariate logistic regression, and the risk factors for the extent of GER were evaluated using multivariate linear regression.

RESULTS

The current study included 601 adult patients, 82 patients with GER and 519 patients without GER. Overall, we noted significant differences between GER and non-GER for pharyngitis, history of GER, other digestive tract diseases, history of asthma, and the use of sufentanil (P < 0.05), while no significant differences between groups were observed for sex, age, type of surgery, operative time, body mass index, intraoperative blood loss, smoking status, alcohol intake, hypertension, diabetes mellitus, psychiatric history, history of respiratory infection, history of surgery, the use of lidocaine, palliative strategies, propofol, or rocuronium bromide, state anxiety inventory, trait anxiety inventory, and self-rating depression scale (P > 0.05). The results of multivariate logistic regression indicated that female sex [odds ratio (OR): 2.702; 95% confidence interval (CI): 1.144-6.378; P = 0.023], increased age (OR: 1.031; 95%CI: 1.008-1.056; P = 0.009), pharyngitis (OR: 31.388; 95%CI: 15.709-62.715; P < 0.001), and history of GER (OR: 11.925; 95%CI: 4.184-33.989; P < 0.001) were associated with an increased risk of GER, whereas the use of propofol could protect against the risk of GER (OR: 0.942; 95%CI: 0.892-0.994; P = 0.031). Finally, age (P = 0.004), operative time (P < 0.001), pharyngitis (P < 0.001), history of GER (P = 0.024), and hypertension (P = 0.017) were significantly associated with GER time.

CONCLUSION

This study identified the risk factors for GER in patients undergoing general anesthesia including female sex, increased age, pharyngitis, and history of GER.

Keywords: Gastroesophageal reflux; Intraoperative period; Risk factors; Anesthesia, General; Surgery; Retrospective studies

Core Tip: The study included 82 patients who reported gastroesophageal reflux (GER) and 519 patients without GER. The results of multivariate logistic regression indicated sex, increased age, pharyngitis, and history of GER were associated with increased risk of GER, whereas the use of propofol could protect against the risk of GER. Finally, age, operative time, pharyngitis, history of GER, and hypertension were significantly associated with GER time.