PDF(Pubmed)
Abstract：
BACKGROUND: Ambulatory surgery is often followed by the development of nausea and/or vomiting (N/V). Although risk factors for postoperative nausea and vomiting (PONV) are frequently discussed, the distinction between PONV and postdischarge nausea and vomiting (PDNV) is unclear. This is especially troublesome given the potential consequences of postdischarge nausea and vomiting (PDNV), which include major discomfort and hospital readmission.
METHODS: In this retrospective cohort study, data from 10,231 adult patients undergoing ambulatory ophthalmology or otolaryngology procedures with general anesthesia were collected and analyzed. Binary and multinomial logistic regression was used to assess the association between patient and anesthetic characteristics (including age, body mass index (BMI), American Society of Anesthesiologists Physical Status (ASA P/S) classification, current smoker status, and intra- and postoperative opioid usage) and the odds ratios of experiencing only PDNV, only PONV, or both PONV and PDNV, as compared to not experiencing N/V at all.
RESULTS: We found that 17.8% of all patients developed N/V (PONV and/or PDNV). Patients who experienced PONV had a 2.79 (95% confidence interval 2.24-3.46) times greater risk of reporting PDNV. Binary logistic regression found that younger age, opioid use, and female sex were associated with an increased likelihood of experiencing any N/V. Increased use of nitrous oxide and a higher ASA P/S class was associated with elevated likelihood of PONV, but not PDNV or PONV plus PDNV.
CONCLUSIONS: Patients experiencing N/V in the PACU are observed to develop PDNV disproportionately by a factor of 2.79. The patients have distinct predictors, indicating important opportunities for care improvements beyond current guidelines.
METHODS: In this retrospective cohort study, data from 10,231 adult patients undergoing ambulatory ophthalmology or otolaryngology procedures with general anesthesia were collected and analyzed. Binary and multinomial logistic regression was used to assess the association between patient and anesthetic characteristics (including age, body mass index (BMI), American Society of Anesthesiologists Physical Status (ASA P/S) classification, current smoker status, and intra- and postoperative opioid usage) and the odds ratios of experiencing only PDNV, only PONV, or both PONV and PDNV, as compared to not experiencing N/V at all.
RESULTS: We found that 17.8% of all patients developed N/V (PONV and/or PDNV). Patients who experienced PONV had a 2.79 (95% confidence interval 2.24-3.46) times greater risk of reporting PDNV. Binary logistic regression found that younger age, opioid use, and female sex were associated with an increased likelihood of experiencing any N/V. Increased use of nitrous oxide and a higher ASA P/S class was associated with elevated likelihood of PONV, but not PDNV or PONV plus PDNV.
CONCLUSIONS: Patients experiencing N/V in the PACU are observed to develop PDNV disproportionately by a factor of 2.79. The patients have distinct predictors, indicating important opportunities for care improvements beyond current guidelines.
摘要：
背景：门诊手术后通常会出现恶心和/或呕吐（N/V）。尽管经常讨论术后恶心和呕吐（PONV）的危险因素，PONV与出院后恶心和呕吐(PDNV)之间的区别尚不清楚.考虑到出院后恶心和呕吐（PDNV）的潜在后果，这尤其麻烦，其中包括严重不适和再次入院。
方法：在这项回顾性队列研究中，我们收集并分析了10,231例接受眼科或耳鼻咽喉科门诊手术的全身麻醉患者的数据.二元和多元逻辑回归用于评估患者与麻醉特征之间的关联（包括年龄，体重指数（BMI），美国麻醉医师协会身体状况（ASAP/S）分类，当前吸烟者状态,以及术中和术后阿片类药物的使用)以及仅经历PDNV的优势比，只有PONV,或者PONV和PDNV，与根本没有经历N/V相比。
结果：我们发现所有患者中有17.8％出现N/V（PONV和/或PDNV）。经历PONV的患者报告PDNV的风险为2.79倍（95％置信区间2.24-3.46）。二元Logistic回归发现，年龄较小，阿片类药物的使用，女性与经历任何N/V的可能性增加有关一氧化二氮的使用增加和较高的AASP/S等级与PONV的可能性升高相关。但不是PDNV或PONV加PDNV。
结论：观察到在PACU中经历N/V的患者以2.79的因子不成比例地发展PDNV。患者有不同的预测因素，表明超出当前指南的护理改善的重要机会。
方法：在这项回顾性队列研究中，我们收集并分析了10,231例接受眼科或耳鼻咽喉科门诊手术的全身麻醉患者的数据.二元和多元逻辑回归用于评估患者与麻醉特征之间的关联（包括年龄，体重指数（BMI），美国麻醉医师协会身体状况（ASAP/S）分类，当前吸烟者状态,以及术中和术后阿片类药物的使用)以及仅经历PDNV的优势比，只有PONV,或者PONV和PDNV，与根本没有经历N/V相比。
结果：我们发现所有患者中有17.8％出现N/V（PONV和/或PDNV）。经历PONV的患者报告PDNV的风险为2.79倍（95％置信区间2.24-3.46）。二元Logistic回归发现，年龄较小，阿片类药物的使用，女性与经历任何N/V的可能性增加有关一氧化二氮的使用增加和较高的AASP/S等级与PONV的可能性升高相关。但不是PDNV或PONV加PDNV。
结论：观察到在PACU中经历N/V的患者以2.79的因子不成比例地发展PDNV。患者有不同的预测因素，表明超出当前指南的护理改善的重要机会。
