Consensus guideline adoption for managing postoperative nausea and vomiting.

OBJECTIVE: Postoperative nausea and vomiting (PONV) is a major source of patient dissatisfaction and is the leading cause of discharge delays and unanticipated postsurgical hospital admissions. The objective of this study was to examine the efficacy of PONV management consensus guidelines at the institutional level.

DESIGN: Retrospective, cross sectional study.

SETTING: Post-anesthesia care unit (PACU) at a 504-bed multispecialty referral center.

PARTICIPANTS: 300 adult surgical patients who underwent general anesthesia prior to institutional adoption of PONV management guidelines and 301 adult surgical patients who underwent general anesthesia following adoption of guidelines.

METHODS: The records of 601 adult surgical patients were examined for documented treatment for PONV while in the PACU, length of PACU stay, medications administered perioperatively, and patient characteristics including number and type of PONV risk factors.

RESULTS: Institutional incidence of PONV decreased from 8.36% to 3.01% following adoption of management guidelines (P = 0.0047). All patients who developed PONV had 3 or more risk factors, and the reduction in incidence is attributable to an overall increase in preoperative antiemetic prophylaxis (P < 0.0001), with a concomitant increase in multimodal treatment (P < 0.0001) and decrease in single modality treatment (P = 0.0004). Length of stay in the PACU increased approximately 15 minutes in patients with PONV, but did not reach statistical significance. Development of PONV was associated with the presence of greater than 3 conventional risk factors (P = 0.009), never smoker status (P = 0.0009), and surgery type.

CONCLUSIONS: Implementation of consensus PONV prevention guidelines significantly reduced incidence at an institutional level. However, patients with 3 or more risk factors remain at risk for PONV. Risk stratification remains important and greater intervention is required in this subgroup at our institution. In response to publication of procedural consensus guidelines, individual institutions should consider modification of practices and assessment of outcomes following application.