This Article Full Text (Publish Ahead of Print[PDF]) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Ruiz, J. R. Articles by Apfel, C. PubMed PubMed Citation Articles by Ruiz, J. R. Articles by Apfel, C.

The Effect of an Anatomically Classified Procedure on Antiemetic Administration in the Postanesthesia Care Unit

Joseph R. Ruiz, MD^*, Spencer S. Kee, MD^*, John C. Frenzel, MD^*, Joe E. Ensor, PhD, Mano Selvan, PhD, Bernhard J. Riedel, MD, PhD, and Christian Apfel, MD, PhD^||

From the Departments of *Anesthesiology and Pain Medicine, Biostatistics and Applied Mathematics, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas; Memorial Hermann Healthcare System, Houston, Texas; Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee; and ||Department of Anesthesiology, University of California San Francisco; UCSF Medical Center at Mt. Zion, San Francisco, California.

Address correspondence and reprint requests to Joseph R. Ruiz, MD, Department of Anesthesiology and Pain Medicine, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe, Unit 409, Houston, TX 77030. Address e-mail to jrruiz{at}mdanderson.org.

Abstract

Background: The effect of the type of surgical procedure on postoperative nausea and vomiting (PONV) rate has been debated in the literature. Our goal in this retrospective database study was to investigate the effect the type of surgical procedure (categorized and compared anatomically) has on antiemetic therapy within 2 h of admission to the postanesthesia care unit (PACU).

Methods: We retrospectively analyzed data for oncology surgeries (n = 18,109), from our automated anesthesia information system database. We classified the types of surgical procedures anatomically into seven categories, with the integumentary musculoskeletal and the superficial surgeries chosen as the referent group. Our analysis included nine other risk factors for each patient, such as gender, smoking status, history of PONV or motion sickness, duration of anesthesia, number of prophylactic antiemetics administered, intraoperative opioids, ketorolac, epidural use, and postoperative opioids. Multivariate logistic regression was used to assess the effect of the type of surgery on antiemetic administration within the first 2 h of PACU admission, while adjusting for the other risk factors.

Results: Compared with integumentary musculoskeletal and superficial surgeries, patients undergoing neurological (P < 0.0001), head or neck (P < 0.0001), and abdominal (P < 0.0001) surgeries were administered PACU antiemetic significantly more often, whereas patients undergoing thoracic surgeries were administered PACU antiemetic significantly less often (P = 0.02). Breast or axilla (P = 0.74) and endoscopic (P = 0.28) procedures did not differ from the referent category. Female, nonsmoker, history of PONV or motion sickness, anesthesia duration, and intraoperative and postoperative opioid administration were significantly associated with antiemetic administration during early PACU admission.

Conclusions: Using our automated anesthesia information system database, we found that the type of surgery, when categorized anatomically, was associated with an increased frequency of early PACU antiemetic administration in our population.