Impact of postoperative nausea and vomiting in the surgical setting

Abstract

SummaryPostoperative nausea and vomiting is one of the most common complications of inpatient and day case surgical procedures. In a climate where total cost of an illness is becoming increasingly important, postoperative nausea and vomiting is a major contributor to direct and indirect costs for both the hospital and patient. In patient terms, the impact of increased recovery room stays and extra nursing time required by PONV patients has been estimated to range from 96-576 more surgical procedures which may be performed in an 'average' day case surgery centre. Postoperative nausea and vomiting is perceived by patients to account for equal or more debilitation than surgery itself and may cause them to lose wages due to absence from work. Reducing the incidence of nausea and vomiting and its associated problems may therefore provide opportunities to improve patient care, decrease the size of waiting lists and improve utilisarion of scarce healthcare resources. Key wordsComplications; emesis. Healthcare; financial implications.Despite the advances made in anaesthesia, postoperative nausea and vomiting (PONV) is one of the most common postoperative complications [l]. Several factors may be associated with and influence PONV, including the patient's gender, weight, age, presurgical anxiety state, as well as the surgical procedure, type and duration of anaesthesia [2-51. The incidence of nausea and vomiting following inpatient surgery has been reported to range from 2543% [6,7]. Studies have indicated that PONV is also commonly associated with day case surgical procedures, with incidences ranging from 845% [8-151. In many healthcare systems, the percentage of surgical procedures performed on a day case basis is increasing, primarily as a means of reducing the costs of inpatient hospital stays. In the USA, the percentage of procedures performed on an outpatient basis has been estimated at approximately 60% [16], while the estimate in Europe is often reported as being between 10% and 30%, depending on the country.Increasing healthcare costs have led to a continual requirement for careful examination of the ultimate impact of diseases and conditions. In pharmacoeconomic terms this is the 'cost of an illness'. It is important to be aware of the total cost of an illness and the elements which contribute to this total cost in order to make informed decisions about alternative interventions for controlling an illness. In order to conduct a cost of illness study, all relevant consequences of the illness need to be determined.The consequences of PONV range from associated resource utilisation to the considerable effect on the patient. To fully examine the impact of any illness, both the direct and indirect associated costs should be considered. Direct costs are those resources (medical and non-medical) consumed to prevent, detect and treat the illness; indirect costs are secondary to the illness, e.g. loss of productivity [17]. In addition to economic costs, the humanistic impact is relevant for most illnesses.The relative i...

Additive anti-emetic efficacy of prophylactic ondansetron with droperidol in out-patient gynecological laparoscopy

“…2 Postoperative nausea and vomiting predisposes patients to increased pain, bleeding, dehydration, electrolyte imbalance and retardation in wound healing, as well as being the principle source of prolonged discharge and unplanned postoperative hospital admission. 3 It is not surprising that PONV following outpatient gynecological surgery has been considered more debilitating than the surgery itself by patients 4 and needs to be addressed further as emphasized by Stockall with research comparing new vs old anti-emetic therapies. 5 It is believed that anti-emetic agents act on the chemoreceptor trigger zone (CTZ) located in the area postrema which contains abundant receptors of various classes (e.g.…”

There is no Difference in the Incidence of Postoperative Nausea and Vomiting (PONV) When Ondansetron (ZOFRAN) is Administered Prior to Induction or Emergence from General Anesthesia

“…PONV can increase the costs of hospitalization by increasing the time spent in the recovery room along with a concomitant increase in staffing requirements, drugs, and supplies. For every additional 2 hours spent in the recovery room due to PONV, one surgical case is delayed, resulting in nonproductive operating room time (Hirsch, 1994). PONV is the most common cause of unplanned hospital admission for outpatient surgical procedures (Hirsch, 1994) .…”

“…For every additional 2 hours spent in the recovery room due to PONV, one surgical case is delayed, resulting in nonproductive operating room time (Hirsch, 1994). PONV is the most common cause of unplanned hospital admission for outpatient surgical procedures (Hirsch, 1994) . Preventing PONV could shorten hospital stays and could also conserve hospital resources and increase productivity in the operating room (Sanchez & Hirsch, 1992).…”

Ondansetrona oral na prevenção de náuseas e vômitos pós-operatórios

“…Entretanto, deste problema originam-se diversos outros: hipocalemia, alcalose hipoclorêmica, desidratação, Síndrome de Mallory-Weiss, broncoaspiração 11 , deiscência de suturas 12 , sangramento intraocular e cutâneo, admissão hospitalar após cirurgias ambulatoriais 13 , desconforto psicológico e prolongamento da internação 14 , com aumento de custos, tanto para o hospital como para o paciente 15 . Intervenções físicas, como acupuntura 16 , acupressão 17,18 , estimulação de baixa-freqüên-cia 19 , bem como diversos agentes farmacoló-gicos como os fenotiazínicos proclorperazina [20][21][22] , prometazina [23][24][25] e perfenazina 26,27 ; os butirofenônicos haloperidol [28][29][30][31] e droperidol 25,[32][33][34][35][36][37][38][39] ; os anti-histamínicos difenidramina (dimenidrato) 40,41 ; hidroxizina 42,43 e ciclizina 4447 ; dentre os anticolinérgicos, a escopolamina 23,4850 ; os benzamídicos como a metoclopramida 33,37,[51][52][53][54][55]…”