A Comprehensive Single-Center Analysis of Postoperative Nausea and Vomiting Following Orthognathic Surgery

Abstract

Background: Postoperative nausea and vomiting (PONV) remains a major clinical end-point for directing enhanced recovery after surgery (ERAS) protocols in facial plastic surgery. This study aimed to identify risk factors for PONV and evaluate strategies for PONV reduction in orthognathic surgery patients. Methods: A retrospective cohort study was performed among patients receiving orthognathic surgery at our institution from 2011 to 2018. Patient demographics, surgical operative and anesthesia notes, medications, and nausea/vomiting were assessed for each patient. The amount of opioid analgesia given both perioperatively and postoperatively was recorded and converted into morphine equivalents (MEQ). Stepwise regression analysis was used to identify significant risk factors for PONV. Post hoc analyses were employed to compare PONV among patients based on MEQ dosage and antiemetic prophylaxis regimes. Results: A total of 492 patients were included; mean age was 23.0 years (range: 13-60); 54.4% were female. The majority of patients received concurrent Le Fort I osteotomy, BSSO, and genioplasty (70.1%). During hospitalization, 59.4% of patients experienced nausea requiring antiemetic medications and 28.4% experienced emesis. Stepwise regression yielded Apfel scores (P ¼ 0.003) and postoperative opioids (P ¼ 0.013) as the strongest predictors of PONV. Post hoc analyses showed that undertreatment with prophylactic antiemetics (based on Apfel) predicted increased PONV (þ12.9%, P ¼ 0.020), and that lower postoperative MEQs (<28.0) predicted decreased PONV (À11.8%, P ¼ 0.01). Conclusions:The study findings confirm the high incidence of PONV among orthognathic surgical patients and stratify previously reported PONV risk factors. More aggressive utilization of antiemetic medications and decreased dependence on opioid analgesia may decrease nausea/vomiting following orthognathic surgery.

Current Orthognathic Surgery Practice Patterns Among Academic OMS

“…This agrees with a single center study by Steinbacher et al where 21% of Le Fort osteotomies were segmental however is in discordance with the NIS data from 1999-2011 where 76% of all Le Fort I osteotomies were segmental. 8,9 The majority of surgeons reported an operative time under 4 h for double jaw orthognathic surgery. The literature demonstrates multiple groups reporting operative times > 4 h, however as longer operative times are associated with increased swelling, rates of postoperative nausea and vomiting (PONV), and longer hospital stays, surgical efficiency has gained focus.…”

“…The literature demonstrates multiple groups reporting operative times > 4 h, however as longer operative times are associated with increased swelling, rates of postoperative nausea and vomiting (PONV), and longer hospital stays, surgical efficiency has gained focus. [9][10][11][12][13][14][15][16] There is limited data regarding the methods of intraoperative blood pressure monitoring for orthognathic surgery patients. In 2021, a single center retrospective study of bimaxillary surgeries by Lee et al documented that 44.2% of surgeries used invasive arterial continuous monitoring.…”

“…This agrees with a single center study by Steinbacher et al where 21% of Le Fort osteotomies were segmental however is in discordance with the NIS data from 1999–2011 where 76% of all Le Fort I osteotomies were segmental. 8,9…”

Gastric Negative Pressure Suction Method Reduces the Incidence of PONV after Orthognathic Surgery

“…In this study, we also excluded patients with the previous PONV, vertigo, migraine, and pharyngitis from this study to reduce confounding factors ( 1 , 5 – 8 ). In order to reduce the possibility of perioperative bleeding, patients with hypertension before an operation should take active treatment to control their blood pressure to within the normal range.…”

“…The incidence of PONV in women is higher than that in men, and increased blood loss results in increased blood swallowing during maxillary surgery. Therefore, we compared whether there were statistically significant differences between the two groups in terms of gender, operation time, operation methods, BMI, and so on ( 3 , 4 , 5 , 8 ). The results showed no statistical difference between the two groups (see Table 1 ).…”