Risk Factors For Postoperative Nausea And Vomiting Research Articles

Analysis of influencing factors and construction of prediction model for postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy: a single-center retrospective cohort study.

With the increasing number of bariatric surgeries, the high incidence of postoperative nausea and vomiting (PONV) associated with this surgery has also gradually attracted attention. Among the common bariatric surgery methods, patients undergoing sleeve gastrectomy (SG) have the highest incidence of nausea and vomiting. The mechanism of occurrence of PONV is very complex. This study aims to explore the influencing factors of PONV in patients undergoing laparoscopic sleeve gastrectomy (LSG) and construct a nomogram prediction model based on these factors. With the approval of the Ethics Committee, the electronic medical records of patients who underwent LSG from July 2022 to May 2023 were collected retrospectively. A total of 114 patients with complete medical records who underwent LSG from July 2022 to May 2023 were included in this study. Among them, 46 patients developed PONV, resulting in a PONV incidence rate of 40.4%. Multivariate logistic regression analysis revealed that female gender, the use of inhalation anesthesia, and operation time ≥ 120min were risk factors for PONV in LSG. Additionally, the use of more than two kinds of antiemetic drugs was identified as a protective factor. Based on these factors, a nomogram model was constructed. PONV in patients undergoing LSG is related to gender, type of anesthesia, duration of surgery, and combination therapy with antiemetic drugs. The nomogram prediction model constructed in this study demonstrates high accuracy and discrimination in predicting the occurrence of PONV in patients undergoing LSG.

Risk factors for postoperative nausea and vomiting after video-assisted thoracic surgery esophagectomy: a prospective cohort study.

Video-assisted thoracic surgery esophagectomy (VATS-E) may increase the risk of postoperative nausea and vomiting (PONV) because it uses a high dosage of anesthesia through a long operative duration. However, no study has examined the risk factors for PONV after VATS-E. Therefore, we investigated the risk factors for PONV to support the appropriate risk management of PONV after VATS-E. This prospective cohort study included 155 patients who underwent VATS-E at the Showa University Hospital between April 1st, 2020 and November 30th, 2022. The primary outcome was the incidence of PONV within 24 h after surgery. Significant independent risk factors associated with the incidence of PONV were selected using multivariate analysis. The association between the number of risk factors for PONV and incidence of PONV was analyzed. One-hundred fifty-three patients were included in the analysis. The patients' median age was 67 years (range, 44-88), and 79.1% were male. PONV occurred in 35 (22.9%) patients. In the multivariate analysis, remifentanil dosage > 89.0 ng/kg/ min, albumin ≤ 3.5 g/dL, and eGFR < 60 mL/min/1.73 m 2 were independent significant risk factors for PONV. A significant association was observed between the incidence of and the number of risk factors for PONV (0 factor, 5.8%; 1 factor, 27.3%; ≥ 2 factors, 40.0%; p = 0.001). These three risk factors are useful indicators for selecting patients at high risk of developing PONV after VATS-E. In these patients, avoiding the development of PONV will be possible by performing appropriate risk management.

Prevalence and Factors Associated with Postoperative Nausea and Vomiting in an Ethiopian Comprehensive Specialized Hospital

Background. Postoperative nausea and vomiting (PONV) is a common and uncomfortable anesthetic and surgical consequences. It may cause severe distress to the patient and may cause the recovery process to be delayed. Identifying the reasons may aid in reducing the magnitude and problems. The purpose of this study was to determine the prevalence and risk factors for PONV after general anesthesia in an Ethiopian hospital. Methods. From March 1 to May 30, 2019, a cross-sectional study was designed. A patient interview was used to obtain data on the occurrence of PONV, and a chart review was used to collect data on other demographic and clinical variables. To identify associated factors, variables with a P-value of 0.2 in binary logistic regression were transformed into a multivariable logistic regression. The strength of the association and level of significance waswere demonstrated using crude and adjusted odds ratios with 95% confidence intervals and P-values of 0.05. Results. The study included 162 participants, with a remarkable 100% response rate. Within 24 hr after surgery, 51.2% of patients had nausea and vomiting. When compared to their counterparts, female patients, patients who received perioperative opioid medication, patients with a history of PONV, and patients with a history of motion sickness reported a statistically significant difference (higher incidence) in PONV. Conclusion. This study only comprised ASA physical classes 1 and 2 patients who did not receive preventive antiemetics. In the research area, the total prevalence of vomiting and nausea was 51.2%. Female sex, perioperative opioid usage, a history of nausea and vomiting, and a history of motion sickness were discovered to be statistically significantly associated with a higher incidence of PONV.

The Association of Guideline-Directed Prophylaxis With Postoperative Nausea and Vomiting in Adult Patients: A Single-Center, Retrospective Cohort Study.

Consensus guidelines for postoperative nausea and vomiting (PONV) prophylaxis recommend a risk-based approach in which the number of antiemetics administered is based on a preoperative estimate of PONV risk. These guidelines have been adapted by the Multicenter Perioperative Outcomes Group (MPOG) to serve as measures of clinician and hospital compliance with guideline-recommended care. However, the impact of this approach on clinical outcomes is not known. We performed a single-center, retrospective study of adult patients undergoing general anesthesia from 2018 to 2021. Risk factors for PONV were defined using MPOG definitions: female sex, history of PONV or motion sickness, nonsmoker, inhaled anesthesia >60 minutes, high-risk procedure (cholecystectomy, laparoscopic, gynecologic), and age <50 years. Adequate prophylaxis was defined using the MPOG PONV-05 metric: at least 2 agents for patients with 1 to 2 risk factors and at least 3 agents for patients with 3+ risk factors. PONV was defined as documented PONV or receipt of rescue antiemetics. To estimate the association between adequate prophylaxis and PONV, we used Bayesian binomial models with overlap propensity score weighting. We included 76,703 cases (43% receiving adequate prophylaxis) with PONV occurring in 19%. In unadjusted and unweighted comparison, adequate prophylaxis was associated with increased incidence of PONV: median odds ratio 1.21 (95% credible interval [1.16-1.25]). However, after propensity score weighting and multivariable adjustment, adequate prophylaxis was associated with reduced relative and absolute risk for PONV: weighted marginal median odds ratio 0.90 [0.84-0.98] and absolute risk reduction (ARR) 1.6% [0.6%-2.6%]. There was evidence for a differential effect of adequate prophylaxis across the guideline-defined risk spectrum, with benefit seen in patients with 1 to 5 risk factors (conditional probabilities of benefit >0.81), but not in those at high predicted risk. Patient-specific, covariate-adjusted ARR was heterogeneous, with a median patient-specific conditional probability of benefit of 0.84 (95% credible interval, 0.73-0.90). Guideline-directed PONV prophylaxis is associated with a modest reduction in PONV, although this effect is small and heterogeneous on the absolute scale. We found evidence for a differential association between adequate prophylaxis and PONV across the guideline-defined risk spectrum, with diminution in patients at very high predicted preoperative risk. While patient-specific benefit was heterogenous, most patients had reasonably high predicted probabilities of absolute benefit from a guideline-directed strategy. Further assessment of these associations in a multicenter setting, with more robust investigation of risk prediction methods will allow for better understanding of the optimal approach to PONV prophylaxis.

A nomogram to predict postoperative nausea and vomiting in the ward following laparoscopic bariatric surgery.

Postoperative nausea and vomiting (PONV) is a common and distressing complication of laparoscopic bariatric surgery (LBS). However, there is a lack of effective integrated prediction models for preventing and treating PONV in patients after LBS. Based on a randomized controlled trial conducted between November 1, 2021, and May 13, 2022, we included 334 participants who underwent LBS according to the inclusion criteria. The database was divided randomly into training and validation cohorts in a ratio of 7:3. Least absolute shrinkage and selection operator plus multivariable logistic regression were used to identify independent predictors and construct a nomogram. The performance of the nomogram was assessed and validated by the area under the receiver operating characteristic curve (AUC), the concordance index (C-index), calibration plots, and a decision curve analysis (DCA). We also explored specific risk factors for PONV in patients with diabetes. The subjects were divided randomly into training (n = 234) and validation (n = 100) cohorts. Age, history of diabetes, type of surgery, and sugammadex use were incorporated to construct a nomogram prediction model. In the training cohort, the AUC and the optimism-corrected C-index were 0.850 [95% confidence interval (CI) 0.801-0.899] and 0.848, while in the validation cohort they were 0.847 (95%CI 0.768-0.925) and 0.844, respectively. The calibration plots showed good agreement between the predicted and actual observations. The DCA results demonstrated that the nomogram was clinically useful. The type of surgery, sugammadex use, and insulin level at 120min were predictors of PONV in patients with diabetes with an AUC of 0.802 (95%CI 0.705-0.898). We developed and validated a prediction model for PONV in patients after LBS. A risk factor analysis of PONV in patients with diabetes provides clinicians with a more precise prophylactic protocol.

Is the reduced risk of post-operative nausea and vomiting in low flow anesthesia applications associated with pre-operative neutrophil/lymphocyte ratio values?

Background/Aim: Post-operative nausea and vomiting (PONV) are defined as nausea and/or vomiting occurring within the first 24 h after surgery and are often observed in the first 2 h after surgery. Only a few previous studies on the use of low fresh gas flow that reduces inhaler agent consumption in laparoscopic cholecystectomy patients at high risk of PONV have been published. Our study aimed to determine the incidence of PONV in the first 30 min and again at 24 h in cases of laparoscopic cholecystectomy in which we applied low fresh gas flow (1 L/min). In addition, we wanted to predict whether the pre-operative neutrophil/lymphocyte ratio (NLR) ≥2 is a risk factor for PONV in our patients to whom we applied low fresh gas flow. Methods: For our prospective cohort study, 80 cases between the ages of 18 and 65, had American Society of Anesthesiologists (ASA) scores of I and II, and who had been scheduled to undergo elective laparoscopic cholecystectomy were included in the study. The NLR limit (calculated by dividing the neutrophil count obtained from the complete blood count before surgery by the lymphocyte count) calculated in the pre-operative period after a patient’s informed consent was obtained was accepted as 2 [5]. Patients were classified into two groups: (1) NLR-I with NLR &lt;2 and (2) NLR-II with NLR ≥2. Premedication was not used in either group. Results: A total of 80 patients were included in the study. They were divided into two groups for classification purposes: (1) NLR-I (n=40) and (2) NLR-II (n=40). The characteristics of the patients in both groups, such as gender distribution, ASA scores, smoking status, mean age, and body mass index (BMI) values, were not different. Sevoflurane consumption in the groups was similar (P=0.169). The time required to complete surgery was longer in the NLR-II group (P=0.025). Nausea/vomiting and antiemetic use were similar in the NLR-I and NLR-II groups in which low fresh gas flow was applied in the first 30 min and 24 h (P=0.500). Although nausea/vomiting was more common in the female and non-smoking group in the first 30 min and 24 h, it was not statistically significantly different from males and smoking groups (P=0.325). However, nausea/vomiting was more common and significantly different in the ASA II versus the ASA I group (P=0.046). The time required to complete surgery was longer, and sevoflurane consumption was higher in patients with nausea and vomiting (P=0.001). Conclusions: Pre-operative NLR as classified by the two groups was not associated with an increase in the risk of PONV in patients to whom we applied low fresh gas flow. A decrease in sevoflurane consumption due to low fresh gas flow may lead to a reduction in the risk of PONV in at-risk patients.

Prevalence, Risk Factors, and Management of Postoperative Nausea and Vomiting After Laparoscopic Sleeve Gastrectomy (a Retrospective Multicentric Study).

Postoperative nausea and vomiting (PONV) is a frequent unappealing laparoscopic sleeve gastrectomy (LSG) sequel. The study's purpose was to determine the prevalence, risk factors of PONV, and management of PONV after LSG. This multicenter retrospective study included patients with morbid obesity who had LSG between January 2022 and April 2023. The age range for LSG was 16 to 65years, and the eligibility requirements included morbid obesity according to international guidelines. PONV was experienced by 74.6% of patients who underwent LSG at 6h postoperative. Multivariate analysis revealed that female gender, smokers, preoperative GERD, gastropexy, and severity of pain were found to be independent risk variables of the development of PONV, while antral preservation, opioid-free analgesia, and intraoperative combined analgesia were found to be independent protective variables against the development of PONV. Combined intravenous ondansetron and metoclopramide improved 92.6% of patients who developed PONV. Dexamethasone and antihistamines drugs are given for 42 cases with persistent PONV after using intravenous ondansetron and metoclopramide. Pain management postoperatively by opioid-free analgesia managed PONV. Helicobacter pylori status has no role in the development of PONV after LSG. Female gender, smoking, presence of preoperative GERD, gastropexy, and severity of pain were found to be independent risk variables of the development of PONV, while antral preservation, opioid-free analgesia, and intraoperative combined analgesia were observed to be independent protective factors against the occurrence of PONV. Combined intravenous ondansetron and metoclopramide improved PONV. Dexamethasone and antihistamines drugs are given for persistent PONV.

5-Hydroxytryptamine and postoperative nausea and vomiting after microvascular decompression surgery

BackgroundThe incidence of postoperative nausea and vomiting (PONV) after microvascular decompression (MVD) surgery is high; however, its underlying mechanisms remain unknown. Serum 5-hydroxytryptamine (5-HT) levels are elevated in patients with PONV. However, the relationship between 5-HT and patients experiencing PONV after MVD surgery is still unknown. Therefore, we hypothesized that 5-HT levels are associated with PONV after MVD surgery. MethodsThis prospective study included 85 patients with hemifacial spasm who received MVD surgery. Blood samples were collected preoperatively, postoperatively, and on postoperative day 1, and cerebrospinal fluid samples were collected intraoperatively. 5-HT levels were detected by enzyme-linked immunosorbent assay (ELISA). The incidence and severity of PONV were evaluated at 2, 6, and 24 h after MVD surgery. ResultsIn the multivariate regression analysis, PONV within 24 h after MVD surgery was associated with elevated cerebrospinal fluid 5-HT levels [odds ratio (OR) = 1.21, 95% confidence interval (CI): 1.01–1.45, p = 0.044], and reduction of intraocular pressure [OR = 11.54, 95% CI: 1.43–92.84, p = 0.022]. Receiver operating characteristic curve analysis revealed an area under the curve of 0.873 (95% CI: 0.77–0.98, p < 0.001). ConclusionOur study found that the cerebrospinal fluid 5-HT levels is an independent risk factor for PONV within 24 h after MVD surgery.

Evaluation of Post-Operative and Post-Discharge Nausea Vomiting and Associated Risk Factors Among Patients Undergoing Ambulatory Laparoscopic Cholecystectomy in Tertiary Care Hospital

Post-operative nausea and vomiting (PONV)may lead to dehydration, bleeding, wound dehiscence, aspiration pneumonitis, and esophageal rupture. Post-discharge nausea and vomiting (PDNV) is acondition occurred during 24-72 hours of discharge. Both conditions have almost the same risk factors. Objective: To determine the frequency of post-operative and post-discharge nausea and vomiting and its associated factors among patients undergoing ambulatory laparoscopic surgery in a Tertiary Care Hospital. Methods: Total 106 patientsrequiring ambulatory laparoscopic surgery were included. Patient was kept under observation for at least 12 hourstill discharge. Post-discharge time of first incidence of nausea and/or vomiting was recorded. Normality was checked through Shapiro-Wilk test. To compare qualitative variables, chi-square test was used. If following Gaussian distribution, quantitative variables were compared using t-test; otherwise, Mann-Whitney U test was used. Logistic regression was applied to get Odd ratios. P-value ≤0.05 was taken as statistically significant. Results: Ketorolac was given to 104(98.1%) patients and only 2(1.9%) received tramadol. The most common complication was excessive bleeding 4(3.8%). Intraoperative opioids were given to 22(20.8%) patients. Post-operative vomiting and nausea among patients were found as 42(39.6%) and 20(18.9%) respectively. Post-discharge nausea and vomiting in patients were found as 14(13.2%) and 6(5.7%) respectively. Conclusions: Highprevalence of PONV and low prevalence of PDNV among patients who underwent ambulatory surgeries were reported. After ambulatory surgery the risk factors for PONV are observed as operation time&gt;1h, female gender, postoperative pain during activitie, and postoperative pain at rest.

Gravid status is not associated with postoperative nausea and vomiting: a matched case-control study.

Postoperative nausea and vomiting (PONV) is a common and unpleasant complication of general anesthesia. There are well-known risk factors that predispose a patient to develop PONV. While studies exist that explore PONV incidence in gravid and non-gravid women separately, limited studies exist to compare the two cohorts to identify if pregnancy is associated with increased risk for PONV or differences in PONV prophylaxis and treatment. This is a retrospective case-control cohort study, with 1:2 matching based on age, year of surgery, and surgical procedure. Electronic medical records were abstracted for demographic information, predisposing risk factors, prophylactic antiemetics, PONV documentation, rescue antiemetics, PACU stay, and length of hospitalization. Analyses of risk factors for PONV were performed using logistic and multinomial logistic regression analyses. 237 gravid women who underwent non-obstetric procedures with general anesthesia were identified and matched with 474 non-gravid women. PONV complicated the course of 51 (21.5%) gravid and 72 (15.2%) non-gravid women. The number of prophylactic antiemetics was fewer among gravid (median 2 [1, 2]) than non-gravid (3 [2, 3]) women (P < 0.001). No association was found between gravid status and risk for PONV (adjusted odds ratio 1.35 [95%CI 0.84, 2.17], P = 0.222). Gravid women had longer hospital lengths of stay (P < 0.001), despite having shorter surgical duration (P = 0.015). The risk for PONV is similar between gravid and similarly aged women. However, anesthesiologists administer fewer prophylactic antiemetics to gravid women during non-obstetric surgery.

The use of aprepitant for the prevention of postoperative nausea and vomiting in endoscopic transsphenoidal pituitary surgery.

Postoperative nausea and vomiting (PONV) are adverse effects after surgery, which may increase the risk of complications. Aprepitant is a neurokinin-1 receptor blocker and has been shown to reduce chemotherapy-related nausea and vomiting and PONV. However, its role in endoscopic skull base surgery remains unclear. The purpose of this study was to evaluate the effect of aprepitant in reducing PONV in endoscopic transsphenoidal (TSA) pituitary surgery. A retrospective chart review between July 2021 and January 2023 of 127 consecutive patients who underwent TSA was performed at a tertiary academic institution. Patients were divided into 2 groups based on preoperative aprepitant use. Two groups were matched based on known risk factors of PONV (age, sex, nonsmoking, and history of PONV). The primary outcome was the incidence of PONV. Secondary outcome measures included the number of anti-emetic use, length of stay, and postoperative cererebrospinal fluid (CSF) leak. After matching, 48 patients were included in each group. The aprepitant group demonstrated a significantly lower incidence of vomiting than the non-aprepitant group (2.1%vs 22.9%, p=0.002). The number of nausea episodes and anti-emetic use decreased with aprepitant use (p<0.05). There was no difference in the incidence of nausea, length of stay, or postoperative CSF leak. Multivariate analysis demonstrated that aprepitant decreased the incidence of postoperative vomiting with odds ratio of 0.107. Aprepitant may serve as a useful preoperative treatment to reduce PONV in patients undergoing TSA. Further studies are needed to evaluate its impact in other arenas of endoscopic skull base surgery.

The Association of Guideline-Directed Prophylaxis with Postoperative Nausea and Vomiting in Pediatric Patients: A Single-Center, Retrospective Cohort Study.

Guidelines for postoperative nausea and vomiting (PONV) prophylaxis in pediatric patients recommend escalation of the number of antiemetics based on a preoperative estimate of PONV risk. These recommendations have been translated into performance metrics, most notably by the Multicenter Perioperative Outcomes Group (MPOG), used at over 25 children's hospitals. The impact of this approach on clinical outcomes is not known. We performed a single-center, retrospective study of pediatric general anesthetic cases from 2018 to 2021. PONV risk factors were defined using MPOG definitions: age ≥3 years, volatile use ≥30 minutes, PONV history, long-acting opioids, female ≥12 years, and high-risk procedure. Adequate prophylaxis was defined using the MPOG PONV-04 metric: 1 agent for 1 risk factor, 2 agents for 2 risk factors, and 3 agents for 3+ risk factors. PONV was defined as documented postoperative nausea/emesis or administration of a rescue antiemetic. Given the nonrandomized allocation of adequate prophylaxis, we used Bayesian binomial models with propensity score weighting. A total of 14,747 cases were included, with PONV in 11% (9% adequate prophylaxis versus 12% inadequate). Overall, there was evidence for reduced incidence of PONV with adequate prophylaxis: weighted median odds ratio 0.82 (95% credible interval, 0.66-1.02; probability of benefit, 0.97) and weighted marginal absolute risk reduction 1.3% (-0.1% to 3.1%). In unweighted estimates, there was an interaction between sum of risk factors and the association of adequate prophylaxis with PONV, with reduced incidence in patients with 1 to 2 risk factors (probability of benefit 0.96 and 0.95) but increased incidence in patients with 3+ risk factors receiving adequate prophylaxis (probability of benefit 0, 0.01, and 0.03 for 3, 4, and 5 risk factors). This was attenuated by weighting, with persistent benefit in 1 to 2 risk factors (probability of benefit 0.90 and 0.94) but equalization of risk in 3+ risk factors. Guideline-directed PONV prophylaxis is inconsistently associated with incidence of PONV across the guideline-defined risk spectrum. This phenomenon, and its attenuation with weighting, is consistent with 2 points: dichotomous risk-factor summation ignores differential effects of individual components, and prognostic information might exist beyond these risk factors. PONV risk at a given sum of risk factors is not homogeneous, but rather is determined by the unique composition of risk factors and other prognostic attributes. These differences appear to have been identified by clinicians, prompting use of more antiemetics. Even after accounting for these differences, however, addition of a third agent did not further reduce risk.

Postoperative Nausea and Vomiting After Orthopaedic Surgery: Prevalence and Associated Factors.

Postoperative nausea and vomiting (PONV) is a common complication after surgery and can lead to additional complications and delayed discharge. This descriptive, cross-sectional study assessed the prevalence of PONV and its associated factors in patients undergoing orthopaedic surgery. The study was conducted between November 2020 and July 2021 with 149 patients in a public hospital in the Central Anatolia region of Turkey. In the first 48 hours after surgery, 40.9% of the patients had nausea and 17.4% had vomiting. Gender, age, medical diagnosis, surgical procedure, operative time, postoperative opioid use, and anxiety were identified as significant risk factors for PONV after orthopaedic surgery (p < .05). These factors should be considered during postoperative follow-up, and patients who are older, female, and have prolonged operative time or anxiety should be monitored more closely for PONV.

Intraoperative Hypotension Is Associated with Postoperative Nausea and Vomiting in the PACU: A Retrospective Database Analysis

Multiple risk factors for postoperative nausea and vomiting (PONV)-a very distressing and outcome-related complication-have been identified, including female sex, absence of a history of smoking, history of PONV, and postoperative opioid use. Evidence of association of intraoperative hypotension with PONV is contradictory. A retrospective analysis of the perioperative documentation of 38,577 surgeries was conducted. The associations between different characterizations of intraoperative hypotension and PONV in the postoperative care unit (PACU) were investigated. First, the relationship between different characterizations of intraoperative hypotension with regard to PONV in the PACU was investigated. Secondly, the performance of the optimal characterization was assessed in an independent dataset derived via random split. The vast majority of characterizations showed an association of hypotension with the incidence of PONV in the PACU. In a multivariable regression, time with a MAP under 50 mmHg showed the strongest association with PONV in terms of the cross-validated Brier score. The adjusted odds for PONV in the PACU were estimated to be 1.34 times higher (95% CI: 1.33-1.35) when a MAP was under 50 mmHg for at least 1.8 min than when a MAP remained above 50 mmHg. The finding indicates that intraoperative hypotension may yet be another risk factor for PONV and therefore emphasizes the importance of intraoperative blood pressure management not only in patients at risk for cardiovascular complications but also in young and healthy patients at risk of PONV.

Incidence and risk factors of postoperative nausea and vomiting following laparoscopic sleeve gastrectomy and its relationship with Helicobacter pylori: A propensity score matching analysis.

Postoperative nausea and vomiting (PONV) are common after laparoscopic sleeve gastrectomy (LSG), affecting patient satisfaction and postoperative recovery. The purpose of this study was to investigate the incidence and severity of PONV after LSG and the relationship between Helicobacter pylori (HP) and PONV. Patients undergoing LSG in our center from June 1, 2018, to May 31, 2022, were divided into HP-positive and HP-negative groups for retrospective analysis. The independent risk factors of PONV were determined by univariate and binary logistic regression analysis using a 1:1 propensity score matching (PSM) method. A total of 656 patients was enrolled, and 193 pairs of HP-positive and negative groups were matched after PSM. Both groups of patients had similar clinical features and surgical procedures. PONV occurred in 232 patients (60.1%) after LSG, and the incidence of PONV in HP-positive patients was 61.10%. The incidence and severity of PONV were statistically similar in both groups (P=0.815). Multivariate analysis showed that the female sex (OR=1.644, P=0.042), postoperative pain (OR=2.203, P=0.001) and use of postoperative opioid (OR=2.229, P=0.000) were independent risk factors for PONV after LSG, whereas T2DM (OR=0.510, P=0.009) and OSAS (OR=0.545, P=0.008) independently reduced the incidence rate of PONV. There was no difference either in smoking (P=0.255) or alcohol drinking (P=0.801). HP infection did not affect PONV (P=0.678). The incidence of PONV following LSG was relatively high. Female sex, postoperative pain and use of postoperative opioid predicted a higher incidence of PONV. Patients with T2DM and OSAS were less likely to have PONV. There was no clear association between HP infection and PONV after LSG.

Risk factors for postoperative nausea and vomiting in patients of orthognathic surgery according to the initial onset time: a cross-sectional study.

A high incidence (40-73%) of postoperative nausea and vomiting (PONV) has been reported following orthognathic surgery, and various risk factors have been associated with it. Identifying PONV risk factors based on initial onset time will help establish preventive measures. This study aimed to identify factors that are significantly related to PONV based on the initial onset time after orthognathic surgery. This study included 590 patients who underwent orthognathic surgery. Multivariate logistic regression analysis was performed to identify the risk factors that are significantly related to PONV. The objective variables were classified into three categories: no PONV, early PONV (initial onset time: 0-2 h after anesthesia), and late PONV (initial onset time: 2-24 h after anesthesia). The explanatory variables included relevant risk factors for PONV, as considered in previous studies. Total intravenous anesthesia with propofol was a significant depressant factor for early PONV (adjusted odds ratio [aOR] = 0.340, 95% confidence interval [CI] = 0.209-0.555) and late PONV (aOR = 0.535, 95% CI = 0.352-0.814). The administration of a combination of intraoperative antiemetics (vs. no administration) significantly reduced the risk of early PONV (aOR = 0.464, 95% CI = 0.230-0.961). Female sex and young age were significant risk factors for late PONV (aOR = 1.492, 95% CI = 1.170-1.925 and unit aOR = 1.033, 95% CI = 1.010-1.057, respectively). We identified factors that are significantly related to PONV based on the initial onset time after orthognathic surgery. Total intravenous anesthesia with propofol significantly reduced the risk of PONV not only in the early period (0-2 h after anesthesia) but also in the late period (2-24 h after anesthesia).

Risk factors of postoperative nausea and vomiting following ambulatory surgery: A retrospective case-control study

ObjectiveTo explore potential risk factors of postoperative nausea and vomiting (PONV) following ambulatory surgery. MethodClinical data of 1670 cases receiving ambulatory surgery in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from September 2017 to December 2019 were retrospectively analyzed. They were categorized to PONV group and non-PONV group, and perioperative data in both groups were analyzed for assessing risk factors of PONV following ambulatory laparoscopy. ResultsThere were 156/1,670 (9.3%) PONV cases, and the female and male incidence in recruited cases was 12.0% and 6.0%, respectively. Analyses on perioperative data of them identified that female gender [adjusted odds ratio (aOR) = 2.060, P < 0.001], operation time >1 h (aOR = 1.554, P = 0.011), postoperative pain at rest (aOR = 1.909, P = 0.013) and postoperative pain during activities (aOR = 3.512, P < 0.001) were independent risk factors of PONV following ambulatory surgery. Furthermore, postoperative pain at rest and during activities were linearly, positively correlated to the incidence of PONV. ConclusionFemale gender, operation time >1 h and postoperative pain are closely related with the incidence of PONV following ambulatory surgery. Alleviating postoperative pain properly is one of the methods to reduce risk factors of PONV following ambulatory surgery.

Prevention of post-operative nausea and vomiting with honey as a pre-operative oral carbohydrate: A randomised controlled pilot trial

Background Post-operative nausea and vomiting (PONV) is the secondmost common post-operative complication. Prolonged pre-operative fasting is common in Australia despite guidelines recommending reduced fasting to improve patient outcomes, such as PONV. Commercially prepared preoperative oral carbohydrate (OC) drinks may be used to reduce fasting time. In this study commercial products were replaced with honey, an inexpensive and common food item. Design Partially blinded, four parallel arms randomised controlled noninferiority trial compared pre-operative OC loading with overnight fasting. Methods Adult elective laparoscopic cholecystectomy and thyroidectomy patients having two or more risk factors for PONV were allocated into intervention and control groups by simple randomisation. The intervention group ingested 60g of honey in 100 ml of water at least two hours before surgery as pre-operative OC loading to reduce PONV. Participants and assessors to the group assignment were blinded to the study outcomes. Early PONV (0–6 hours) was measured with Rhodes index of nausea, vomiting and retching (R-INVR) and a numeric rating scale (NRS). Results The four groups (N = 142) were control and intervention groups of thyroidectomy patients (n = 72: C = 37, I = 35), and control and intervention groups of laparoscopic cholecystectomy patients (n = 70: C = 37, I = 33) and had similar distributions of variables. The estimated effect size was 140 with a 95 percent confidence interval. The PONV incidence (Pearson χ2 = 4.54; df = 1; p = 0.03) and severity were significantly lower in the laparoscopic cholecystectomy intervention group (R-INVR: Mann–Whitney U = 446.5; p = 0.01; NRS: Mann–Whitney U = 444.5; p = 0.01) and results were not conclusive in the thyroidectomy group (NRS: Mann–Whitney U = 629.5; p = 0.95; R-INVR: Mann–Whitney U = 629.5; p = 0.76). Conclusion Honey could be recommended as an inexpensive pre-operative OC to reduce PONV in adult patients receiving general anaesthesia.

The effect of Apfel risk score and fasting times on postoperative nausea and vomiting: Post-Operative Nausea and Vomiting

BackgroundPostoperative nausea and vomiting (PONV) is an undesirable problem with many adverse effects on the patient. The first step toward effective treatment and prevention is to identify the patient's risk factors for PONV. This descriptive, cross-sectional study was conducted in the General Surgery Clinic between August 2017 and August 2018 to evaluate the effect of Apfel risk score and fasting duration on PONV and draw attention to this issue. MethodsA total of 283 patients who were scheduled for elective surgery were included in the study. The patients were evaluated using the Patient Evaluation Form created by the researcher by scanning the literature, and the Apfel Risk Scoring System. ResultsThe solid fasting time of the patients was 18.9 ± 28.9 h, the mean fluid fasting time was 13.9 ± 7.4 h, the mean operation time was 133 ± 76 min, the perceived hunger score was 3.1 ± 3.2, and the mean thirst score was 4.3 ± 3.2 and 16.8 ± 18.5. When the Apfel Risk Score and the incidence of all-time postoperative nausea and vomiting (PONV) were compared, a significant correlation was found between the patients' solid food fasting times and the incidences of the 2nd, 4th, 8th, and 24th hours. PONV incidence (p ˂ 0.01). ConclusionThe fasting times of the patients are longer than recommended. There is a parallel relationship between both long fasting times and the Apfel risk score and the incidence of PONV. It is recommended that institutions establish an evidence-based policy and take the necessary precautions in the preoperative evaluation of patients in terms of postoperative nausea and vomiting and during fasting periods.

A Clinical Risk Analysis of Postoperative Nausea and Vomiting After Colorectal Cancer Surgery

Abstract Objective Postoperative nausea and vomiting (PONV) is a frequent complication following colorectal surgery. The present study investigated the risk factors for PONV after colorectal cancer surgery. Methods A retrospective study of 204 patients who underwent surgery for colorectal cancer was conducted. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with PONV. Results The overall incidence of postoperative nausea (PON) and postoperative vomit (POV) was 26.5% (54/204), and 12.3% (25/204), respectively. The univariate analysis showed that female gender (p &lt; 0.001), no current alcohol drinking habit (p = 0.003), and no stoma creation (p = 0.023) were associated with PON. Postoperative vomit was significantly correlated with female gender (p = 0.009), high body mass index (p = 0.017), and right-sided colon cancer (p = 0.001). The multivariate logistic regression analysis revealed that female gender (odds ratio [OR]: 4.225; 95% confidence interval [CI]: 2.170–8.226; p &lt; 0.001) was an independent risk factor for PON. A high body mass index (OR: 1.148; 95%CI: 1.018–1.295; p = 0.025), and right-sided colon cancer (OR: 3.337; 95%CI: 1.287–8.652; p = 0.013) were independent risk factors for POV. Conclusion Our findings suggest that female gender for PON and a high body mass index and right-sided colon cancer for POV are risk factors after colorectal cancer surgery. An assessment using these factors might be helpful for predicting PONV.