Factors associated with failure of postoperative nausea and vomiting prophylaxis in a high complexity health center in Cali, Colombia: case-control study
Postoperative nausea and vomiting (PONV) negatively impact patients undergoing surgical procedures under anesthesia. The scientific evidence on the risk factors for PONV after antiemetic prophylaxis is unsatisfactory, so there is a need to identify the factors associated with the occurrence of PONV.
To identify the factors associated with failed prophylaxis for PONV in patients at Fundación Valle del Lili in 2017.
Case-control study. Patients admitted to the post anesthesia care unit after having undergone surgery under general anesthesia were included. The cases were patients who, despite receiving antiemetic prophylaxis, had PONV, and those who did not develop these symptoms after prophylaxis, were considered the control group. A bivariate analysis was conducted using the Mann-Whitney U test, Fisher's exact test, or x2, according to the type of variable. Finally, crude odds ratios were estimated and subsequently adjusted via a logistic regression.
A total of 80 cases and 332 controls were included. The median age for all patients was 47 years. Women represented 61.6% (n = 254). The variables associated with PONV were age (odds ratio [OR] = 0.98, 95% confidence interval [CI] 0.96-0.99, P = 0.013), female (OR = 3.02, 95% CI 1.66-5.47, P < 0.001) and the use of desflurane during surgery (OR = 2.82, 95% CI 1.097.30, P < 0.032).
Female sex and the use of desflurane during surgery increase the odds of experiencing PONV, regardless of pharmacological antiemetic prophylaxis. Moreover, elderly patients show lower odds of developing this complication.
2. Irefin SA, Farid IS, Senagore AJ. Urgent colectomy in a patient with membranous tracheal disruption after severe vomiting. Anesth Analg 2000;91:1300-1302.
3. Toprak V, Keles GT, Kaygisiz Z, et al. Subcutaneous emphysema following severe vomiting after emerging from general anesthesia. Acta Anaesthesiol Scand 2004;48:917-918.
4. Gold BS, Kitz DS, Lecky JH, et al. Unanticipated admission to the hospital following ambulatory surgery. JAMA 1989;262:3008-3010.
5. Apfel CC, Meyer A, Orhan-Sungur M, et al. Supplemental intravenous crystalloids for the prevention of postoperative nausea and vomiting: quantitative review. Br J Anaesth 2012;108:893-902.
6. Apfel CC, Laara E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999;91:693-700.
7. Palazzo M, Evans R. Logistic regression analysis of fixed patient factors for postoperative sickness: a model for risk assessment. Br J Anaesth 1993;70:135-140.
8. Lee A, Fan LT. Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev 2009;CD003281.
9. Rowbotham DJ. Recent advances in the non-pharmacological management of postoperative nausea and vomiting. Br J Anaesth 2005;95:77-81.
10. Apfel CC, Korttila K, Abdalla M, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 2004;350:2441-2451.
11. Gan TJ, Diemunsch P, Habib AS, Kovac A, Kranke P, Meyer TA, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2014;118:85-113. DOI: 10.1213/ANE.0000000000000002.
12. Burtles R, Peckett BW. Postoperative vomiting; some factors affecting its incidence. Br J Anaesth 1957;29:114-123.
13. Apfel CC, Heidrich FM, Jukar-Rao S, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth 2012;109:742-753.
14. Yi MS, Kang H, Kim MK, et al. Relationship between the incidence and risk factors of postoperative nausea and vomiting in patients with intravenous patient-controlled analgesia. Asian J Surg 2018;41:301-306.
15. Chatterjee S, Rudra A, Sengupta S. Current concepts in the management of postoperative nausea and vomiting. Anesthesiol Res Pract 2011;2011:748031.
16. Apfel CC, Kranke P, Katz MH, et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth 2002;88:659-668.
17. Matsuura H, Inoue S, Kawaguchi M. The risk of postoperative nausea and vomiting between surgical patients received propofol and sevoflurane anesthesia: a matched study. Acta Anaesthesiol Taiwan 2016;54:114-120.
18. Choi JB, Shim YH, Lee YW, et al. Incidence and risk factors of postoperative nausea and vomiting in patients with fentanyl-based intravenous patient-controlled analgesia and single anti-emetic prophylaxis. Yonsei Med J 2014;55:1430-1435.
19. Yoon IJ, Kang H, Baek CW, et al. Comparison of effects of desflurane and sevoflurane on postoperative nausea, vomiting, and pain in patients receiving opioid-based intravenous patient-controlled analgesia after thyroidectomy: propensity score matching analysis. Medicine (Baltimore) 2017;96: e6681.
20. Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Anesthesiology 1999;91:109-118.
21. Apfel CC, Philip BK, Cakmakkaya OS, et al. Who is at risk for postdischarge nausea and vomiting after ambulatory surgery? Anesthesiology 2012;117:475-186.
22. Apfel CC, Kranke P, Eberhart LHJ, et al. Comparison of predictive models for postoperative nausea and vomiting. Br J Anaesth 2002;88:234-240.