Postoperative and Postdischarge Nausea & Vomiting following Ambulatory Surgery: A Retrospective Cohort Study comparing Incidence and Associated factors

Abstract

BackgroundAmbulatory surgery is often followed by the development of nausea & vomiting (N/V). Although risk factors for postoperative nausea & vomiting (PONV) are often studied, PONV is not well understood in context of a patient’s home. This is especially troublesome given the potential consequences of postdischarge nausea & vomiting (PDNV), which include major discomfort and hospital readmission.MethodsIn this retrospective cohort study, data from 10,231 adult patients undergoing ambulatory surgery with general anesthesia were collected and analyzed. Multivariable multinomial logistic regression was used to assess the association between patient & operative characteristics (including age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, current smoker status, and intra & postoperative opioid usage) and the odds of experiencing N/V only in the postanesthesia care unit (PACU), only at home, or in the PACU and at home, as compared to not experiencing N/V at all. ResultsIn this study, 17.8% of all patients developed N/V in at least one location following ambulatory surgery with general anesthesia. Patients who experienced N/V in the PACU had 3.05 (95% confidence interval: 2.55-3.65) times the risk of reporting N/V at home than those who did not. Multivariable multinomial logistic regression found that younger age, greater hydromorphone use, and female sex were associated with increased likelihood of experiencing N/V in all settings. Increased morphine usage was found to be associated with greater odds of experiencing Home only and PACU plus Home N/V, but not PACU only N/V. Greater oxycodone and volatile anesthetic usage were associated with lower and higher odds of experiencing PACU only N/V respectively, but neither were significantly associated with Home only and PACU plus Home N/V.ConclusionsPatients experiencing N/V in the PACU are observed to develop PDNV disproportionately. N/V at home and N/V in the PACU, while having some overlap, are associated with several unique indicators, including usage of oxycodone, morphine, and volatile anesthetics. More investigation into PDNV specific indicators and prevention strategies is warranted. Trial RegistrationN/A