Reducing the Incidence of PONV in Facial Feminization Surgery through a Standardized Anesthetic Regimen

Abstract

Introduction: Postoperative nausea and vomiting (PONV) continues to be a major issue for patients undergoing facial feminization surgery (FFS In this study, we aim to examine risk factors and the incidence of PONV before and after the implementation of a new anesthetic and antiemetic regimen throughout all surgical stages; preoperative, intraoperative, and postoperative. Methods: A retrospective cohort study was performed on 158 patients who received FFS at an academic medical institution’s center for transgender medicine and surgery between 2018 and 2022. Of these, 117 patients underwent FFS with no specific antiemetic regimen, and were given antiemetics for nausea or vomiting as seen fit by their surgeon, and 41 patients underwent FFS with the new intervention. Odds Ratios were computed via logistic regression using RStudio to adjust for age, BMI, and smoking status (defined as a patient reported “ever smoker” vs “never smoker”). Results: 80 out of 117 (68%) patients on the old regimen experienced PONV, compared with 8 out of 41 (19%) of patients on the new regimen. After adjusting for age, BMI, and smoking status, the new regimen is associated with a 6 fold reduction in PONV, with a calculated odds ratio of 0.15 (95% CI: 0.06, 0.36; p = 3.9x10^-5) compared with the old regimen. Conclusion: Among patients undergoing FFS, a novel antiemetic regimen reduced the incidence of PONV by 6-fold when compared with standard of care. By introducing an appropriate antiemetic prophylaxis, tailored specifically to curb PONV, providers can ensure a more comfortable postoperative experience for patients.