Who Is at Risk for Postdischarge Nausea and Vomiting after Ambulatory Surgery?

• Published in: Anesthesiology (Philadelphia) 2012-09, Vol.117 (3), p.475-486
• Main Authors: APFEL, Christian C, PHILIP, Beverly K, HOOPER, Vallire D, RADKE, Oliver C, RUIZ, Joseph, KOVAC, Anthony, CAKMAKKAYA, Ozlem S, SHILLING, Ashley, SHI, Yun-Ying, LESLIE, John B, ALLARD, Martin, TURAN, Alparslan, WINDLE, Pamela, ODOM-FORREN, Jan
• Format: Article
• Language: English
• Subjects: Adult; Aged; Ambulatory Surgical Procedures; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antiemetics - therapeutic use; Biological and medical sciences; Female; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Patient Discharge; Postoperative Nausea and Vomiting - etiology; Risk Factors; ROC Curve
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/aln.0b013e318267ef31

About one in four patients suffers from postoperative nausea and vomiting. Fortunately, risk scores have been developed to better manage this outcome in hospitalized patients, but there is currently no risk score for postdischarge nausea and vomiting (PDNV) in ambulatory surgical patients. We conducted a prospective multicenter study of 2,170 adults undergoing general anesthesia at ambulatory surgery centers in the United States from 2007 to 2008. PDNV was assessed from discharge until the end of the second postoperative day. Logistic regression analysis was applied to a development dataset and the area under the receiver operating characteristic curve was calculated in a validation dataset. The overall incidence of PDNV was 37%. Logistic regression analysis of the development dataset (n=1,913) identified five independent predictors (odds ratio; 95% CI): female gender (1.54; 1.22 to 1.94), age less than 50 yr (2.17; 1.75 to 2.69), history of nausea and/or vomiting after previous anesthesia (1.50; 1.19 to 1.88), opioid administration in the postanesthesia care unit (1.93; 1.53 to 2.43), and nausea in the postanesthesia care unit (3.14; 2.44-4.04). In the validation dataset (n=257), zero, one, two, three, four, and five of these factors were associated with a PDNV incidence of 7%, 20%, 28%, 53%, 60%, and 89%, respectively, and an area under the receiver operating characteristic curve of 0.72 (0.69 to 0.73). PDNV affects a substantial number of patients after ambulatory surgery. We developed and validated a simplified risk score to identify patients who would benefit from long-acting prophylactic antiemetics at discharge from the ambulatory care center.