Postdischarge Nausea and Vomiting Remains Frequent After Le Fort I Osteotomy Despite Implementation of a Multimodal Antiemetic Protocol Effective in Reducing Postoperative Nausea and Vomiting

Abstract

Purpose To assess the prevalence of postdischarge nausea and vomiting (PDNV) after Le Fort I osteotomy with and without the use of a multimodal antiemetic protocol shown to decrease postoperative nausea and vomiting (PONV). Materials and Methods Consecutive patients undergoing Le Fort I osteotomy with or without additional procedures at a single academic institution formed the intervention cohort for an institutional review board–approved prospective clinical trial with a retrospective comparison group. The intervention cohort was managed with a multimodal antiemetic protocol. The comparison group consisted of consecutive patients who underwent similar surgical procedures at the same institution before protocol implementation. All patients were asked to complete a postdischarge diary documenting the occurrence of nausea and vomiting. Those who completed the diaries were included in this analysis. Data were analyzed with the Fisher exact test and the Wilcoxon rank sum test. A P value less than .05 was considered significant. Results Diaries were completed by 85% of patients in the intervention group (79 of 93) and 75% of patients in the comparison group (103 of 137). Patients in the intervention (n = 79) and comparison (n = 103) groups were similar in the proportion of patients with validated risk factors for PDNV, including female gender, history of PONV, age younger than 50 years, opioid use in the postanesthesia care unit (PACU), and nausea in the PACU (P = .37). The prevalence of PDNV was unaffected by the antiemetic protocol. After discharge, nausea was reported by 72% of patients in the intervention group and 60% of patients in the comparison group (P = .13) and vomiting was reported by 22% of patients in the intervention group and 29% of patients in the comparison group (P = .40). Conclusion Modalities that successfully address PONV after Le Fort I osteotomy might fail to affect PDNV, which is prevalent in this population. Future investigation will focus on methods to minimize PDNV.

Efficacy of PECS block in addition to multimodal analgesia for postoperative pain management in patients undergoing outpatient elective breast surgery: A retrospective study

“…No subjects experienced delayed hospital discharge, remained in the hospital after surgery due to PONV or were admitted after discharge due to delayed PONV (DPONV). The overall and between-group incidence of PONV in this study is lower than the prevalence reported in recent literature for ambulatory surgery ( 49 , 50 ) and specifically for breast surgery ( 35 , 45 , 51 , 52 ). The fact that opioid consumption in our study was comparable between groups most likely did not allow for a significant inter-group difference in PONV.…”

Implementation of Postoperative Nausea and Vomiting Guidelines for Female Adult Patients Undergoing Anesthesia During Gynecologic and Breast Surgery in an Ambulatory Setting

“…12 A multicenter cohort study of patients undergoing ambulatory surgery under general anesthesia (GA) in the United States reported 37% of patients experienced postdischarge nausea and vomiting. 13 The estimated costs of PONV in the ambulatory surgical setting can range from $250,000 to $1.5 million in lost surgical revenue. 14,15…”

Postoperative nausea and vomiting in patients undergoing colorectal surgery within an institutional enhanced recovery after surgery protocol: comparison of two prophylactic antiemetic regimens

“…The incidence of late PONV (POD 2–5 days) was also higher (35%–45%) and the concern of delayed PONV was addressed recently [16,17]. Although there are abundant data on PONV occurrence until 24 h postoperatively, delayed PONV and post-discharge nausea and vomiting after ambulatory surgery deserve further investigation [18–20].…”