An exploratory study of the relationship between postoperative nausea and vomiting and postdischarge nausea and vomiting in children undergoing ambulatory surgery

Paediatr Anaesth. 2019 Apr;29(4):353-360. doi: 10.1111/pan.13612.

Abstract

Background: The factors contributing to postoperative nausea and vomiting in children have been identified, but there have been no reported studies that have studied pediatric postdischarge nausea and vomiting.

Aims: This preliminary study aimed to identify the factors affecting postdischarge nausea and vomiting in ambulatory children, specifically whether postoperative nausea and vomiting factors are contributory.

Methods: One hundred and twenty-two pediatric patients aged 5-10 years undergoing elective ambulatory surgery participated in this institution-approved study. After obtaining written parental consent and patient assent when indicated, child self-ratings of nausea and pain were completed preoperatively and at discharge, and for 3 days postdischarge. Questionnaires were returned by mail, with a 64% return rate. Using stepwise logistic regression with backward elimination, three separate analyses were undertaken to predict the following outcomes: nausea present in recovery, nausea present on postoperative day 1, and emesis on day of surgery.

Results: Nearly half (47%) of our cohort experienced nausea at the time of discharge; 11% had emesis on day of surgery. On postoperative day 1, there was a 15% incidence of nausea with a 3% incidence of emesis. In the multiple logistic regression analyses, nausea at discharge was predicted by male gender (odds ratio 2.5, 95% CI: 1.0-6.2) and the presence of pain on discharge (odds ratio 3.0, 95% CI: 1.0-9.2). Emesis on day of surgery was predicted by the presence of nausea at discharge (odds ratio 16.9, 95% CI: 1.8-159.3) and having a family history of nausea/vomiting (odds ratio 8.3, 95% CI: 1.6-43.4). The presence of nausea on postoperative day 1 was predicted only by the presence of nausea on discharge (odds ratio 3.7, 95% CI: 1.2-11.1).

Conclusion: Our preliminary data indicate that postoperative nausea and vomiting may persist into the postdischarge period and pain may be a contributing factor.

Keywords: Pediatric ambulatory discharge; Pediatric nausea; Pediatric vomiting; Postdischarge nausea; Postdischarge vomiting.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ambulatory Surgical Procedures / adverse effects
  • Ambulatory Surgical Procedures / statistics & numerical data*
  • Anesthesia Recovery Period
  • Anesthesia, General / adverse effects
  • Anesthesia, General / statistics & numerical data
  • Antiemetics / therapeutic use
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Incidence
  • Male
  • Ondansetron / therapeutic use
  • Pain, Postoperative
  • Patient Discharge
  • Postoperative Nausea and Vomiting / epidemiology*
  • Prospective Studies
  • Self Report

Substances

  • Antiemetics
  • Ondansetron