An exploratory study of the relationship between postoperative nausea and vomiting and postdischarge nausea and vomiting in children undergoing ambulatory surgery

Abstract

Background:The factors contributing to postoperative nausea and vomiting in children have been identified, but there have been no reported studies that have studied pediatric postdischarge nausea and vomiting.Aims: This preliminary study aimed to identify the factors affecting postdischarge nausea and vomiting in ambulatory children, specifically whether postoperative nausea and vomiting factors are contributory. Methods:One hundred and twenty-two pediatric patients aged 5-10 years undergoing elective ambulatory surgery participated in this institution-approved study. After obtaining written parental consent and patient assent when indicated, child self-ratings of nausea and pain were completed preoperatively and at discharge, and for 3 days postdischarge. Questionnaires were returned by mail, with a 64% return rate.Using stepwise logistic regression with backward elimination, three separate analyses were undertaken to predict the following outcomes: nausea present in recovery, nausea present on postoperative day 1, and emesis on day of surgery.Results: Nearly half (47%) of our cohort experienced nausea at the time of discharge; 11% had emesis on day of surgery. On postoperative day 1, there was a 15% incidence of nausea with a 3% incidence of emesis. In the multiple logistic regression analyses, nausea at discharge was predicted by male gender (odds ratio 2.5, 95% CI:1.0-6.2) and the presence of pain on discharge (odds ratio 3.0, 95% CI: 1.0-9.2).Emesis on day of surgery was predicted by the presence of nausea at discharge (odds ratio 16.9, 95% CI: 1.8-159.3) and having a family history of nausea/vomiting (odds ratio 8.3, 95% CI: 1.6-43.4). The presence of nausea on postoperative day 1 was predicted only by the presence of nausea on discharge (odds ratio 3.7, 95% CI: 1.2-11.1). Conclusion:Our preliminary data indicate that postoperative nausea and vomiting may persist into the postdischarge period and pain may be a contributing factor. K E Y W O R D S

American Society of Anesthesiologists Physical Status Classification as a reliable predictor of postoperative medical complications and mortality following ambulatory surgery: an analysis of 2,089,830 ACS-NSQIP outpatient cases

“…For example, since patients must provide self-care after ambulatory surgery, it is possible that poor health literacy may be associated with adverse outcomes [ 15 , 16 ]. In addition, family support may also be a factor determining outcomes, especially for more vulnerable patients (e.g., seniors) [ 17 ].…”

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

“…and Kocaturk et al . 40 , 41 found that when PONV persisted into the postdischarge period, pain was often a contributing factor. Turgut et al .…”

“…Alternative treatments for active PONV include intravenous metoclopramide (10 mg), droperidol (0.625 mg), promethazine (6.25–12.5 mg), dolasetron (12.5 mg), granisetron (0.1 mg), palonosetron (0.075mg), or tropisetron (0.5 mg) 419 , 420 . Algorithms describing how to identify high-risk patients and how to guide the administration of multimodal treatments can significantly reduce the incidence of PONV and PDNV 40 , 421 – 423 . Yazbeck-Karam et al .…”

Aggressive Prophylactic Treatments for Postoperative Nausea and Vomiting Improve Outcomes in Pediatric Adenotonsillectomy Procedure

“…2,7,8 Despite these efforts, current interventions still lack universal efficacy. Chandrakantan et al 9 recently reported that neither ondansetron nor dexamethasone is proved effective in preventing nausea, either alone or in combination. In our hospital, PONV still occurs frequently despite a standard institutional guideline that includes routinely rehydration with 10 mL/kg IV fluid, and administration of ondansetron and dexamethasone in children above 2 years of age.…”