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The postoperative interview: assessing risk factors for nausea and vomiting
M M Cohen1, P G Duncan, D P DeBoer
1Clinical Epidemiology Unit, Sunnybrook Health Science Centre, North York, Ontario, Canada.
Anesthesia and Analgesia
|January 1, 1994
Summary
This study identified key risk factors for postoperative nausea and vomiting (PONV), finding significant variations across hospitals and anesthesiologists. Patient-reported outcomes highlight persistently high PONV rates before newer antiemetics.
Area of Science:
- Anesthesiology
- Patient Safety
- Surgical Outcomes
Background:
- Postoperative nausea and vomiting (PONV) is a common complication.
- Previous studies often focused on single etiologic factors.
- Standardized assessment methods for PONV symptoms were lacking.
Purpose of the Study:
- Identify risk factors for PONV.
- Examine surgery type impact on PONV in female patients.
- Investigate hospital and anesthesiologist variations in PONV rates.
- Determine if case-mix explained inter-hospital differences.
Main Methods:
- Utilized postoperative interview data from 16,000 inpatients across four teaching hospitals (1988-89).
- Employed a closed-question standardized format for interviews conducted by research nurses.
- Applied multiple logistic regression analysis to control for multiple risk factors simultaneously.
Main Results:
- Identified significant PONV risk factors: younger age, female sex, lower physical status, no preoperative conditions, nonsmokers, elective procedures, longer anesthesia, inhaled anesthetics, intraoperative opioids, gynecologic/ophthalmologic surgery.
- Minor gynecologic surgery showed increased risk in women (relative odds = 2.30).
- Marked variations in PONV rates (39%-73%) existed across hospitals and anesthesiologists, unexplained by patient case-mix.
Conclusions:
- Patient-reported PONV rates were persistently high prior to the introduction of modern antiemetic drugs.
- Significant inter-hospital and inter-anesthesiologist variability in PONV rates suggests modifiable factors.
- A comprehensive, multi-factorial approach is crucial for understanding and managing PONV.