Incidence and predictors of postdischarge nausea and vomiting in a 7-day population

• Published in: Journal of clinical anesthesia 2013-11, Vol.25 (7), p.551-559
• Main Authors: Odom-Forren, Jan, PhD, RN, CPAN, FAAN, Jalota, Leena, MD, Moser, Debra K., DNSc, RN, FAAN, Lennie, Terry A., PhD, RN, FAAN, Hall, Lynne A., DrPH, RN, Holtman, Joseph, MD, PhD, Hooper, Vallire, PhD, RN, CPAN, FAAN, Apfel, Christian C., PhD, MD
• Format: Article
• Language: English
• Subjects: Adult; Airway management; Ambulatory surgery; Ambulatory Surgical Procedures; Anesthesia; Anesthesia & Perioperative Care; Anesthesia, General - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antiemetics - therapeutic use; Biological and medical sciences; Confidence intervals; Diaries; Emesis control; Female; Humans; Incidence; Male; Medical sciences; Middle Aged; Models, Statistical; Narcotics; Nausea; Ondansetron; Ondansetron - therapeutic use; Outpatient anesthesia; Pain; Pain Medicine; Pain, Postoperative - epidemiology; Patient satisfaction; Postdischarge nausea and vomiting; Postoperative Nausea and Vomiting - epidemiology; Prospective Studies; Risk Factors; ROC Curve; Severity of Illness Index; Studies; Surgery; Time Factors; Vomiting
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2013.05.008

Abstract Study Objective 1) To quantify the incidence and severity of postdischarge nausea and vomiting (PDNV) for 7 days in adults undergoing outpatient surgeries with general anesthesia; 2) to evaluate whether a risk model previously developed for the first two postoperative days may be used to predict the patient’s risk of PDNV for 7 days; and 3) to verify whether the same risk factors are applicable in the 3 to 7 day period. Design Prospective study. Setting Two university-affiliated centers. Patients 248 adult (> 18 years) surgical outpatients undergoing ambulatory surgical procedures with general anesthesia between 2007 and 2008. Measurements The incidence and severity of PDNV and a simplified risk score for PDNV was assessed prospectively from discharge up to 7 postoperative days. Main Results The overall incidence of nausea was 56.9% and of emesis was 19.4%. The incidence of PDNV was highest on the day of surgery (DOS), with PDNV of 44.8% and decreasing over time to 6.0% on day 7. Using the simplified risk score for PDNV the area under the receiver operating characteristic (ROC) curve was 0.766 (0.707, 0.825). A previous history of postoperative nausea and vomiting (PONV; OR 3.51, CI 1.70 - 7.27), operating room time (odds ratio [OR] 2.19, 95% CI 1.34 - 3.60), use of ondansetron in the Postanesthesia Care Unit (PACU; OR 6.39, CI 1.65-24.79), and pain during days 3–7 (OR 1.67, CI 1.30 - 2.14) were the strongest predictors of PDNV on days 3–7. Conclusions PDNV affects a significant number of patients after ambulatory surgery, and our simplified PDNV score may be applied to a 7-day population. Pain appears to be a factor in late PDNV. It is possible that the presence of PDNV during days 3–7 has different origins from the PDNV that resolved over the first 48 hours.