Risk factors for postoperative nausea and vomiting

Area of Science:

• Anesthesiology
• Perioperative Medicine
• Clinical Risk Assessment

Background:

• Postoperative nausea and vomiting (PONV) poses a significant challenge in anesthesia.
• Identifying reliable risk factors is crucial for effective prophylactic management.
• Research since the 1990s has utilized logistic regression and meta-analyses to identify PONV predictors.

Purpose of the Study:

• To review and synthesize established and potential risk factors for postoperative nausea and vomiting.
• To evaluate the accuracy of current PONV risk scoring systems.
• To suggest future research directions for improving PONV prediction.

Main Methods:

• Systematic review and meta-analysis of published literature on PONV risk factors.
• Analysis of logistic regression studies identifying independent predictors.
• Evaluation of current risk scoring system accuracy.

Main Results:

• Established risk factors include female gender, nonsmoking, history of PONV/motion sickness, younger age, longer surgery, volatile anesthetics, nitrous oxide, neostigmine, and opioids.
• Potential factors include migraine history, family history, ASA status, anxiety, ethnicity, fluid administration, anesthesia duration, and anesthesia type.
• Disproved factors include early menstruation, obesity, and lack of oxygen.
• Current risk scoring systems achieve 55%-80% accuracy.

Conclusions:

• Several clinical and anesthetic factors are well-established predictors of PONV.
• Further research into genetic and under-investigated patient characteristics is needed.
• Involving pediatric and outpatient populations will enhance predictive models for PONV.