Incidence and associated factor of Postoperative nausea and vomiting after Anesthesia in Nakohn Phanom Hospital

Abstract

Objective: To determine the incidence of postoperative nausea and vomiting (PONV) in the Nakhon Phanom hospital, as well as the associated factors of postoperative nausea and vomiting.

Materials and Method: This is the Etiognostic research (Retrospective case control study).

Medical record of 981 patients at aged 15-80 years underwent anesthesia at Nakhon Phanom Hospital between November 1st - December 31th,2019 were included and divided into PONV group 162 patients and non-PONV group 819 patients. The patient’s characteristics, anesthetic techniques, and surgical techniques were gathered. Postoperative nausea and vomiting were graded into mild, moderate, and severe categories and assessed immediately in the recovery room and within the first 24 hours following surgery. Incidence of postoperative nausea and vomiting were determined, general data were analyzed using descriptive statistics. Factors associated with postoperative nausea and vomiting were analyzed using univariable logistic regression and multivariable logistic regression

Results: The patient's age was 43.6 ± 16.7, and 54.5% were female. Incidences of PONV were 17%; of these, 17.3% were mild, 66.1% were moderate, 16.7% were severe cases.  In PONV group 82.1% of patients were female, 45.7% were general surgery patients and 30.9% were OB-GYN patients. When analyzing the anesthetic techniques, found that the PONV group received general anesthesia in 73.5%, and spinal anesthesia with intrathecal morphine in 17.3%. The duration of anesthesia in the PONV group was 72 ± 59.2 minutes, compared to 59 ± 35 minutes in the non-PONV group. Only 9.3% of patients with PONV smoked (OR 0.21, 95 % CI 0.12 - 0.37, p = < 0.001), but Age, ASA classification, and co-morbidity did not differ between the 2 groups. In the univariable analysis, PONV was higher in females OR 4.76 (95 % CI 3.11 - 7.27, p = < 0.001), general surgery OR 1.50 (95 % CI 1.07 - 2.11, p = 0.019), OB-GYN surgery OR 2.30 (95 % CI 1.57 - 3.37, p = < 0.001), higher in patients receive spinal anesthesia with intrathecal morphine OR 3.68 (95 % CI 2.21 - 6.12, p = < 0.001). We found that in orthopedic surgery OR 0.29 (95 % CI 0.16 - 0.52, p = < 0.001), urological surgery OR 0.28 (95 % CI 0.09 - 0.92, p = 0.036), spinal anesthesia OR 0.42 (95 % CI 0.21 - 0.85, p = 0.015), and total intravenous anesthesia OR 0.14 (95 % CI 0.03 - 0.58, p = 0.007) was not associated with PONV. When analyzed in a multivariable analysis, female aOR 2.88 (95%CI 1.61-5.17, p<0.001), general anesthesia aOR 19.09 (95%CI 3.39-107.44, p=0.001), spinal anesthesia with intrathecal morphine aOR 47.53 (95%CI 7.43-304.06, p<0.001) were risk factors associated with PONV. In addition, it was discovered that patients with BMI < 18.5 also associated with PONV aOR 2.04 (95%CI 1.12-3.71, p=0.019).

Conclusion: At Nakhon Phanom Hospital, Incidence of postoperative nausea and vomiting occurred in 17 %. Female, BMIs under 18.5, and those who had general anesthesia, spinal anesthesia, spinal anesthesia with intrathecal morphine were at higher risk of PONV.