Incidence and Risk Factors of Postoperative Nausea- Vomiting after Implementation of Prophylaxis Guideline

Abstract

Introduction: Postoperative nausea-vomiting (PONV) is one of the major complications in patients undergoing general anesthesia with incidence between 20% and 30%. PONV can cause serious problems. Our department has developed and implemented a PONV prophylaxis guideline for high risk PONV patients since 2013, however, PONV still presents. Objective: To identify the incidence and risk factors of PONV after implementation of PONV prophylaxis guideline. Methods: A retrospective study was performed in 443 adult patients undergoing elective surgery under general anesthesia in Srinagarind Hospital from January 2014 to December 2014 to identify the incidence and risk factors of PONV. From literature review, we identified 20 risk factors for PONV. All relevant risk factors were assessed for crude odds and adjusted odds ratios using binary logistic regression analysis to identify the relevant risk factors. Results: The incidence of PONV was 10.8%. Female gender had a risk ratio of 2.663 (95% CI: 1.350-5.255). Patients who had postoperative numeric pain score (NRS) ≥ 5 had risk ratio of 2.040 (95% CI: 1.084-4.228). Interestingly, combined general anesthetic technique with spinal or epidural block could reduce PONV with risk ratio of 0.278 (95% CI: 0.100-0.777). Conclusion: After implementation of PONV prophylaxis guideline, the incidence of PONV is 10.8%. The risk factors for PONV are female gender and postoperative NRS ≥ 5, while combined general anesthesia with spinal or epidural block reveals protective effect.