Incidence and factors associated with postoperative nausea and vomiting among elective adult surgical patients at University of Gondar comprehensive specialized hospital, Northwest Ethiopia, 2019: A cross-sectional study

Incidence and risk factors of postoperative nausea and vomiting in Africa among patient under gone surgery: a systematic review and meta-analysis

Background

Patients who experience postoperative nausea and vomiting are not happy with their surgical outcomes. Preventing this problem expedites the patients' return to normal activities following surgery and significantly increases their satisfaction. There are no condensed results that show the prevalence and contributing variables of postoperative nausea and vomiting in Africa. Thus, the purpose of this meta-analysis and comprehensive review was to ascertain the prevalence and contributing variables of postoperative nausea and vomiting in Africa.

Methods

Studies were retrieved from the PubMed, EMBASE, Cochrane Database, CINAHL, Scopus, Mednar, and Google Scholar databases using combinations of searching terms and Boolean operators. I-squared (I 2) statistics is used for evaluating study heterogeneity. Every publication is assessed for methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal criteria. Using a funnel plot, publication bias is visually assessed. Subgroup analyses investigate the source of heterogeneity. To determine whether publication bias exists, the Eggers weighted regression test is employed. STATA software version 14 was used to perform statistical analyses.

Results

In Africa, the combined incidences of nausea 24.96 % (95% CI: 17.903-32.018), vomiting 23.655 % (95% CI: 17.542-29.769) and nausea with vomiting 15.27 % (95% CI: 9.118-21.424) . History of motion sickness (odds ratio [OR]: 3.19 (95% CI 1.08-9.42), P < 0.036) and history of postoperative nausea and vomiting (OR: 4.33 (95% CI 2.654-7.07), P < 0.001) were factors linked to postoperative nausea and vomiting. Compared to their counterparts, patients who underwent more risky surgical procedures had a 1.4-fold increased chance of developing postoperative nausea and vomiting. Patients who skipped the use of prophylactic medication for nausea and vomiting had a 59% higher risk of experiencing postoperative nausea and vomiting than those who did [OR: 1.39 (95% CI (1.074-1.769), P < 0.012) and OR: 0.194 (95% CI (0.04-0.935), P < 0.001)], respectively.

Conclusion

Postoperative nausea and vomiting were more common in surgically treated African individuals. Clinical interventions are needed to prevent, diagnose, and treat postoperative nausea and vomiting (PONV), with a focus on patients who have experienced motion sickness, high-risk surgery, or PONV in the past. It is advisable to use whole intravenous anesthesia based on Propofol for surgery, if feasible.

Comparison of predictive models in postoperative nausea and vomiting in patients undergoing breast cancer surgery

BACKGROUND

Post-operative nausea and vomiting remain an unresolved concern in Türkiye and some parts of the world, impacting the quality of the patient's recovery process and diminishing overall satisfaction.

OBJECTIVE

This study was conducted as a descriptive investigation to compare the incidence of nausea and vomiting following breast cancer surgery with the nausea and vomiting risk scores proposed by Apfel and Koivuranta.

METHODS

This study was conducted with 100 patients admitted to the General Surgery service of a university hospital between 31 August 2019 and 31 May 2021 for breast cancer surgery. The patient information form developed by the researchers, Apfel Nausea and Vomiting Risk Score, and Koivuranta Nausea and Vomiting Risk Score were used as data collection tools.

RESULTS

It was identified that 61% of the patients experienced nausea and vomiting within the initial 24 h following surgery. A significant correlation was found between age, post-operative opioid use, motion sickness or history of PONV, and nausea and vomiting (p < 0,05). The sensitivity of the Apfel score obtained was 80%, the specificity was 46%, and the AUC value was 0.686. The sensitivity of the Koivuranta score was 80%, the specificity was 35%, and the AUC value was 0.675 (p < 0.05).

CONCLUSION

It has been observed that patients experience high rates of nausea and vomiting after breast cancer surgery and that the Apfel and Koivuranta Risk Scores are equally applicable in predicting post-operative nausea and vomiting.

Prevalence and associated factors of postoperative nausea and vomiting among adult patients undergoing elective surgery

Background

Postoperative nausea and vomiting (PONV) is a surgical complication defined as any nausea, and vomiting with in the first 24-48 h after surgery in inpatients. Nausea is the unpleasant desire and urge to vomit, while vomiting is a forcing of gastric contents through the mouth. Nausea and vomiting is the most common complication associated anaesthesia and surgery in the postoperative period. It is considered one of the most common causes of morbidity, and it has significant effects on patient satisfaction.

Objective

The study aimed to assess the incidence and associated factors of postoperative nausea and vomiting.

Methods

A cross-sectional study was conducted from 1 February to 30 April 2022. All adult, elective patients who underwent elective surgery under anaesthesia during the study period were included. A total of 677 patients underwent elective surgery at the time of the study, of which 634 patients were included in the study. Data collection method included chart review and patient interview.

Result

The overall prevalence of postoperative nausea and vomiting among post-surgical patients was 35.4%. Factors that had statistically significant relationship with PONV were history of motion sickness [adjusted odds ratio (AOR) 4.04, 95% CI 1.486-10.988], smoking history (AOR 0.37, 95% CI 0.128-1.042) and intraoperative opioid use (AOR 3.59, 95% CI 1.345-9.618).

Conclusion

The prevalence of this study is higher than studies conducted in the recent years. This result showed that the appropriate practice of PONV prophylactic regimens and anaesthesia management are required to decrease the risk of PONV.

Prevalence and Factors Associated with Postoperative Nausea and Vomiting in an Ethiopian Comprehensive Specialized Hospital

Background

Postoperative nausea and vomiting (PONV) is a common and uncomfortable anesthetic and surgical consequences. It may cause severe distress to the patient and may cause the recovery process to be delayed. Identifying the reasons may aid in reducing the magnitude and problems. The purpose of this study was to determine the prevalence and risk factors for PONV after general anesthesia in an Ethiopian hospital.

Methods

From March 1 to May 30, 2019, a cross-sectional study was designed. A patient interview was used to obtain data on the occurrence of PONV, and a chart review was used to collect data on other demographic and clinical variables. To identify associated factors, variables with a P-value of 0.2 in binary logistic regression were transformed into a multivariable logistic regression. The strength of the association and level of significance waswere demonstrated using crude and adjusted odds ratios with 95% confidence intervals and P-values of 0.05.

Results

The study included 162 participants, with a remarkable 100% response rate. Within 24 hr after surgery, 51.2% of patients had nausea and vomiting. When compared to their counterparts, female patients, patients who received perioperative opioid medication, patients with a history of PONV, and patients with a history of motion sickness reported a statistically significant difference (higher incidence) in PONV.

Conclusion

This study only comprised ASA physical classes 1 and 2 patients who did not receive preventive antiemetics. In the research area, the total prevalence of vomiting and nausea was 51.2%. Female sex, perioperative opioid usage, a history of nausea and vomiting, and a history of motion sickness were discovered to be statistically significantly associated with a higher incidence of PONV.

Postoperative Nausea and Vomiting After Orthopaedic Surgery: Prevalence and Associated Factors

Postoperative nausea and vomiting (PONV) is a common complication after surgery and can lead to additional complications and delayed discharge. This descriptive, cross-sectional study assessed the prevalence of PONV and its associated factors in patients undergoing orthopaedic surgery. The study was conducted between November 2020 and July 2021 with 149 patients in a public hospital in the Central Anatolia region of Turkey. In the first 48 hours after surgery, 40.9% of the patients had nausea and 17.4% had vomiting. Gender, age, medical diagnosis, surgical procedure, operative time, postoperative opioid use, and anxiety were identified as significant risk factors for PONV after orthopaedic surgery (p < .05). These factors should be considered during postoperative follow-up, and patients who are older, female, and have prolonged operative time or anxiety should be monitored more closely for PONV.

Investigating the Association Between a Risk-Directed Prophylaxis Protocol and Postoperative Nausea and Vomiting: Validation in a Low-Income Setting

BACKGROUND

The efficacy of postoperative nausea and vomiting (PONV) prevention protocols in low-income countries is not well known. Different surgical procedures, available medications, and co-occurring diseases imply that existing protocols may need validation in these settings. We assessed the association of a risk-directed PONV prevention protocol on the incidence of PONV and short-term surgical outcomes in a teaching hospital in Rwanda.

METHODS

We compared the incidence of PONV during the first 48 hours postoperatively before (April 1, 2019-June 30, 2019; preintervention) and immediately after (July 1, 2019-September 30, 2019; postintervention) implementing an Apfel score-based PONV prevention strategy in 116 adult patients undergoing elective open abdominal surgery at Kigali University Teaching Hospital in Rwanda. Secondary outcomes included time to first oral intake, hospital length of stay, and rate of wound dehiscence. Interrupted time series analyses were performed to assess the associated temporal slopes of the outcome before and immediately after implementation of the risk-directed PONV prevention protocol.

RESULTS

Compared to just before the intervention, there was no change in the odds of PONV at the beginning of the postintervention period (odds ratio [OR], 0.23; 95% confidence interval [CI], 0.05-1.01). There was a decreasing trend in the odds of nausea (OR, 0.60; 95% CI, 0.36-0.97) per month. However, there was no difference in the incidence of nausea immediately after implementation of the protocol (OR, 0.96; 95% CI, 0.25-3.72) or in the slope between preintervention and postintervention periods (OR, 1.48; 95% CI, 0.60-3.65). In contrast, there was no change in the odds of vomiting during the preintervention period (OR, 1.01; 95% CI, 0.61-1.67) per month. The odds of vomiting decreased at the beginning of the postintervention period compared to just before (OR, 0.10; 95% CI, 0.02-0.47; P = .004). Finally, there was a significant decrease in the average time to first oral intake (estimated 14 hours less; 95% CI, -25 to -3) when the protocol was first implemented, after adjusting for confounders; however, there was no difference in the slope of the average time to first oral intake between the 2 periods ( P = .44).

CONCLUSIONS

A risk-directed PONV prophylaxis protocol was associated with reduced vomiting and time to first oral intake after implementation. There was no substantial difference in the slopes of vomiting incidence and time to first oral intake before and after implementation.

Predictors of Postoperative Nausea and Vomiting After Same-Day Surgery: A Retrospective Study

PURPOSE

Postoperative nausea and vomiting (PONV) are main issues after same-day surgery. This study aimed to retrospectively evaluate the electronic medical records of patients who underwent same-day operations under general anesthesia to identify the potential risk factors for PONV.

METHODS

Records of 7759 adult patients who received general anesthesia with remifentanil were reviewed. The patients were assessed for the incidence and severity of PONV. Multiple logistic regression was used to identify risk factors for PONV. A nomogram was established to predict PONV after same-day operations.

FINDINGS

Of 7759 patients, 2317 (29.9%) experienced PONV. In multiple logistic regression analysis, female sex, nonsmoker status, history of motion sickness or nausea, high body mass index (BMI), long surgical duration, laparoscopic procedure, and preoperative analgesic intake within 30 days were independent risk factors for PONV. No correlation was found between the severity of PONV and remifentanil exposure (odds ratio = 1.018; 95% CI, 0.861-1.204; P = 0.834) or remifentanil dose (odds ratio = 1.294; 95% CI, 0.760-2.205; P = 0.343). For the nomogram, which involved sex, laparoscopic procedure, BMI, history of nausea or motion sickness, and analgesic intake within 30 days, the receiver operating characteristic analysis revealed that the AUC values in the training and validation cohorts were 0.81 and 0.83, respectively.

IMPLICATIONS

Predictors for PONV in same-day surgery include female sex, nonsmoker, history of motion sickness or nausea, high BMI, surgical duration >1 hour, laparoscopic procedure, and preoperative analgesic intake within 30 days. A new predictive model is feasible for predicting the incidence of PONV based on the preoperative and intraoperative predictors.

Assessment of pain and postoperative nausea and vomiting and their association in the early postoperative period: an observational study from Palestine

BACKGROUND

Postoperative nausea and vomiting (PONV) and postoperative pain (POP) are most commonly experienced in the early hours after surgery. Many studies have reported high rates of PONV and POP, and have identified factors that could predict the development of these complications. This study aimed to evaluate the relationship between PONV and POP, and to identify some factors associated with these symptoms.

METHODS

This was a prospective, multicentre, observational study performed at An-Najah National University Hospital and Rafidia Governmental Hospital, the major surgical hospitals in northern Palestine, from October 2019 to February 2020. A data collection form, adapted from multiple previous studies, was used to evaluate factors associated with PONV and POP in patients undergoing elective surgery. Patients were interviewed during the first 24 h following surgery. Multiple binary logistic regression was applied to determine factors that were significantly associated with the occurrence of PONV.

RESULTS

Of the 211 patients included, nausea occurred in 43.1%, vomiting in 17.5%, and PONV in 45.5%. Multiple binary logistic regression analysis, using PONV as a dependent variable, showed that only patients with a history of PONV [odds ratio (OR) = 2.28; 95% confidence interval (CI) = 1.03-5.01; p = 0.041] and POP (OR = 2.41; 95% CI = 1.17-4.97; p = 0.018) were significantly associated with the occurrence of PONV. Most participants (74.4%) reported experiencing pain at some point during the first 24 h following surgery. Additionally, the type and duration of surgery were significantly associated with POP (p-values were 0.002 and 0.006, respectively).

CONCLUSIONS

PONV and POP are common complications in our surgical patients. Factors associated with PONV include a prior history of PONV and POP. Patients at risk should be identified, the proper formulation of PONV protocols should be considered, and appropriate management plans should be implemented to improve patients' outcomes.