Simplified algorithm for the prevention of postoperative nausea and vomiting: a before-and-after study

Objective: To develop a patient risk stratification algorithm that will reduce the incidence of postoperative nausea and vomiting (PONV) in an ambulatory plastic surgery practice by increasing the use of prophylactic medications as the risk of PONV increases. Design: Retrospective review of an ambulatory plastic surgery practice before and after a PONV patient risk stratification algorithm was introduced. A patient risk stratification algorithm was developed based on known causes of PONV. Incidence of patients experiencing PONV before and after the introduction of the patient risk stratification algorithm was compared. Results of the study were analyzed with logistic regression. Results: The rate of PONV was 17.7% before the patient risk stratification algorithm was instituted and 4.47% after. This difference is significant (one-sided P value against no difference in true incidence of PONV = .003). A history of PONV and longer lengths of anesthesia were associated with higher likelihoods of PONV (P = .02 and .0056, respectively), and application of our patient algorithm (ie, membership in the study group as opposed to the control group) was associated with a lower likelihood of PONV (P < .001). Conclusion: Patient risk stratification and a multimodality approach to PONV prophylaxis effectively reduce the rate of PONV in an ambulatory plastic surgery practice.

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A Single Perioperative Injection of Dexamethasone Decreases Nausea, Vomiting, and Pain after Laparoscopic Donor Nephrectomy

Journal of Transplantation ◽

10.1155/2017/3518103 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Shigeyoshi Yamanaga ◽

Andrew Mark Posselt ◽

Chris Earl Freise ◽

Takaaki Kobayashi ◽

Mehdi Tavakol ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Donor Nephrectomy ◽

Nausea And Vomiting ◽

Complication Rates ◽

Opioid Use ◽

Laparoscopic Donor Nephrectomy ◽

Before And After

Background. A single dose of perioperative dexamethasone (8–10 mg) reportedly decreases postoperative nausea, vomiting, and pain but has not been widely used in laparoscopic donor nephrectomy (LDN). Methods. We performed a retrospective cohort study of living donors who underwent LDN between 2013 and 2015. Donors who received a lower dose (4–6 mg) (n=70) or a higher dose (8–14 mg) of dexamethasone (n=100) were compared with 111 donors who did not receive dexamethasone (control). Outcomes and incidence of postoperative nausea, vomiting, and pain within 24 h after LDN were compared before and after propensity-score matching. Results. The higher dose of dexamethasone reduced postoperative nausea and vomiting incidences by 28% (P=0.010) compared to control, but the lower dose did not. Total opioid use was 29% lower in donors who received the higher dose than in control (P=0.004). The higher dose was identified as an independent factor for preventing postoperative nausea and vomiting. Postoperative complication rates and hospital stays did not differ between the groups. After propensity-score matching, the results were the same as for the unmatched analysis. Conclusion. A single perioperative injection of 8–14 mg dexamethasone decreases antiemetic and narcotic requirements in the first 24 h, with no increase in surgical complications.

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