INCIDENCE AND RISK FACTORS OF POSTOPERATIVE NAUSEA AND VOMITING IN LAPAROSCOPIC SURGERIES: A PROSPECTIVE OBSERVATIONAL STUDY AT A TERTIARY CARE HOSPITAL
Main Article Content
Keywords
Postoperative Nausea and Vomiting, Laparoscopic Surgery, Apfel Score, Risk Factors, Antiemetic Prophylaxis
Abstract
Postoperative nausea and vomiting (PONV) remains a significant complication following laparoscopic surgery, affecting patient satisfaction, recovery, and healthcare costs. This study aimed to determine the incidence of PONV and identify associated risk factors in patients undergoing laparoscopic procedures at a tertiary care institution.
Methods: This prospective observational cohort study was conducted at Gian Sagar Hospital and Medical College, Patiala, from September 2022 to February 2023. A total of 142 adult patients undergoing elective laparoscopic surgeries under general anesthesia were enrolled using consecutive sampling. The Apfel simplified risk score was calculated preoperatively. Patients were assessed for PONV occurrence at standardized intervals (0-2, 2-6, 6-12, and 12-24 hours postoperatively). Data on demographic characteristics, anesthetic techniques, surgical parameters, and postoperative pain were collected. Multivariate logistic regression analysis identified independent risk factors.
Results: The overall incidence of PONV within 24 hours was 45.1 percent. PONV incidence increased progressively with Apfel risk score: 16.7% (score 0), 23.7% (score 1), 43.5% (score 2), 67.6% (score 3), and 83.3% (score 4). Independent risk factors identified included female gender (adjusted OR=3.82, p<0.001), non-smoking status (aOR=2.64, p=0.028), history of PONV/motion sickness (aOR=2.86, p=0.003), use of volatile anesthetics (aOR=2.48, p=0.022), surgical duration exceeding 90 minutes (aOR=2.34, p=0.015), nitrous oxide administration (aOR=1.98, p=0.044), and postoperative pain with VAS>4 (aOR=2.26, p=0.017).
Conclusion: PONV incidence following laparoscopic surgery remains substantial. The Apfel scoring system demonstrated excellent predictive validity. Implementation of risk-stratified multimodal prophylactic strategies including propofol-based anesthesia and optimized analgesia is recommended for high-risk patients.
References
• Apfel, C. C., Läärä, E., Koivuranta, M., Greim, C. A., & Roewer, N. (1999). A simplified risk score for predicting postoperative nausea and vomiting: Conclusions from cross-validations between two centers. Anesthesiology, 91(3), 693-700. https://doi.org/10.1097/00000542-199909000-00022
• Apfel, C. C., Roewer, N., Korttila, K., Kerger, H., & Kranke, P. (2002). Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: A randomized controlled trial of factorial design. British Journal of Anaesthesia, 88(5), 659-668. https://doi.org/10.1093/bja/88.5.659
• Domino, K. B., Anderson, E. A., Polissar, N. L., & Posner, K. L. (1999). Comparative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting: A meta-analysis. Anesthesia & Analgesia, 88(6), 1370-1379. https://doi.org/10.1097/00000539-199906000-00032
• Eberhart, L. H., Högel, J., Seeling, W., Staack, A. M., Geldner, G., & Georgieff, M. (2000). Evaluation of three risk scores to predict postoperative nausea and vomiting. Acta Anaesthesiologica Scandinavica, 44(4), 480-488. https://doi.org/10.1034/j.1399-6576.2000.440422.x
• Gan, T. J., Diemunsch, P., Habib, A. S., Kovac, A., Kranke, P., Meyer, T. A., Watcha, M., Chung, F., Angus, S., Apfel, C. C., Bergese, S. D., Candiotti, K. A., Chan, M. T., Davis, P. J., Hooper, V. D., Lagoo-Deenadayalan, S., Myles, P., Nezat, G., Philip, B. K., & Tramèr, M. R. (2014). Consensus guidelines for the management of postoperative nausea and vomiting. Anesthesia & Analgesia, 118(1), 85-113. https://doi.org/10.1213/ANE.0000000000000002
• Horn, C. C., Wallisch, W. J., Homanics, G. E., & Williams, J. P. (2014). Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting. European Journal of Pharmacology, 722, 55-66. https://doi.org/10.1016/j.ejphar.2013.10.037
• Koivuranta, M., Läärä, E., Snåre, L., & Alahuhta, S. (1997). A survey of postoperative nausea and vomiting. Anaesthesia, 52(5), 443-449. https://doi.org/10.1111/j.1365-2044.1997.117-az0113.x
• Kranke, P., Eberhart, L. H., Apfel, C. C., Broscheit, J., Geldner, G., & Roewer, N. (2002). Tropisetron for prevention of postoperative nausea and vomiting: A quantitative systematic review. Anaesthesist, 51(10), 805-814. https://doi.org/10.1007/s00101-002-0366-4
• Lee, A., & Done, M. L. (2004). Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane Database of Systematic Reviews, 3, CD003281. https://doi.org/10.1002/14651858.CD003281.pub2
• McKenzie, R., Tantisira, B., Karambelkar, D. J., Riley, T. J., & Abdelhady, H. (1994). Comparison of ondansetron with ondansetron plus dexamethasone in the prevention of postoperative nausea and vomiting. Anesthesia & Analgesia, 79(5), 961-964. https://doi.org/10.1213/00000539-199411000-00024
• Odom-Forren, J., Jalota, L., Moser, D. K., Lennie, T. A., Hall, L. A., Holtman, J., Hooper, V., & Apfel, C. C. (2013). Incidence and predictors of postdischarge nausea and vomiting in a 7-day population. Journal of Clinical Anesthesia, 25(7), 551-559. https://doi.org/10.1016/j.jclinane.2013.05.008
• Pierre, S., Benais, H., & Pouymayou, J. (2002). Apfel's simplified score may favourably predict the risk of postoperative nausea and vomiting. Canadian Journal of Anaesthesia, 49(3), 237-242. https://doi.org/10.1007/BF03020521
• Qian, Y., Zhu, J. K., Hou, B. L., Sun, Y. E., Gu, X. P., & Ma, Z. L. (2022). Risk factors of postoperative nausea and vomiting following ambulatory surgery: A retrospective case-control study. Heliyon, 8(12), e12430. https://doi.org/10.1016/j.heliyon.2022.e12430
• Rodseth, R. N., Gopalan, P. D., Cassimjee, H. M., & Goga, S. (2011). Reduced incidence of postoperative nausea and vomiting in black South Africans and its utility for a modified risk scoring system. Anesthesia & Analgesia, 112(6), 1392-1397. https://doi.org/10.1213/ANE.0b013e3182185504
• Scuderi, P. E., James, R. L., Harris, L., & Mims, G. R. (2000). Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy. Anesthesia & Analgesia, 91(6), 1408-1414. https://doi.org/10.1097/00000539-200012000-00022
• Shaikh, S. I., Nagarekha, D., Hegade, G., & Marutheesh, M. (2016). Postoperative nausea and vomiting: A simple yet complex problem. Anesthesia: Essays and Researches, 10(3), 388-396. https://doi.org/10.4103/0259-1162.179310
• Smith, C. A., & Ruth-Sahd, L. (2016). Reducing the incidence of postoperative nausea and vomiting begins with risk screening: An evaluation of the evidence. Journal of PeriAnesthesia Nursing, 31(2), 158-171. https://doi.org/10.1016/j.jopan.2015.03.011
• Sneyd, J. R., Carr, A., Byrom, W. D., & Bilski, A. J. (1998). A meta-analysis of nausea and vomiting following maintenance of anaesthesia with propofol or inhalational agents. European Journal of Anaesthesiology, 15(4), 433-445. https://doi.org/10.1046/j.1365-2346.1998.00319.x
• Tramèr, M. R., Moore, R. A., Reynolds, D. J., & McQuay, H. J. (1997). Quantitative estimation of rare adverse events which follow a biological progression: A new model applied to chronic NSAID use. Pain, 85(1-2), 169-182. https://doi.org/10.1016/S0304-3959(99)00267-5
• Wallenborn, J., Gelbrich, G., Bulst, D., Behrends, K., Wallenborn, H., Rohrbach, A., Krause, U., & Kühnast, T. (2006). Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone: Randomised double blind multicentre trial. British Medical Journal, 333(7563), 324. https://doi.org/10.1136/bmj.38903.419549.80
• Watcha, M. F., & White, P. F. (1992). Postoperative nausea and vomiting: Its etiology, treatment, and prevention. Anesthesiology, 77(1), 162-184. https://doi.org/10.1097/00000542-199207000-00023
• Weilbach, C., Rahe-Meyer, N., Raymondos, K., Weissig, A., Scheinichen, D., & Piepenbrock, S. (2006). Postoperative nausea and vomiting (PONV): Usefulness of the Apfel-score for identification of high risk patients for PONV. Acta Anaesthesiologica Belgica, 57(4), 361-363.
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Dr Prakash Chandra
Assistant Professor, Department of Anesthesiology, Gian Sagar Hospital & Medical College, Patiala, Punjab, India.
