Incidence of Post-Discharge Nausea and Vomiting Higher Than Expected

Author: Chase Doyle

Anesthesiology News

A prospective survey of patients undergoing outpatient surgery has identified a high incidence of post-discharge nausea and vomiting (PDNV).

Results of the online survey showed that more than one-third of patients experienced nausea within three days of discharge. Despite the high prevalence of this condition, only a small percentage of patients took medications to treat their symptoms. According to the study authors, perioperative care teams should be educated about the high incidence of PDNV and take precautions to optimize modifiable risk factors.

“The incidence of PDNV was definitely higher than we thought it was going to be,” said Adam K. Jacob, MD, a consultant in the Department of Anesthesiology and Perioperative Medicine and an associate professor of anesthesiology at Mayo Clinic, in Rochester, Minn. “These results reinforce the need to utilize non–opiate-based approaches to pain relief and to use an aggressive PDNV protocol in patients found to be at higher risk.”

“We came to the realization at our surgery centers that we lack good metrics about what happens to our patients following discharge,” Dr. Jacob said. “While patients are here, we provide high-quality care, but after they go home, we don’t know much about how they do. PDNV is [a] quality metric that has grown in recognition globally, and there’s real interest in understanding the frequency with which it develops.”

At the American Association of Nurse Anesthetists 2018 Annual Congress (abstract A74), co-author Lisa Saunders, RN, BSN, reported that the overall response rate was 63% (N=357). Data from responders showed 34.7% experienced nausea within three days of discharge, 8.3% experienced vomiting, and 7.2% experienced retching. Moreover, of the individuals reporting nausea, the authors noted that 28.8% ranked their nausea to be a 5 or higher on a Likert scale from 0 to 10, with 10 signifying very severe nausea.

“As a practice, we felt like we were quite aggressive about trying to give anti-nausea medications while patients were in our presence,” Dr. Jacob said. “Given that a third of our patients are developing nausea when they go, however, there is clearly an opportunity for us to improve.”

According to Dr. Jacob, the results of the study support the need for multimodal approaches to both pain and nausea prevention to decrease reliance on opioids in the PACU and reduce the incidence of PDNV. Dr. Jacob also noted that he was encouraged by the possibility of conducting future follow-up care via web-based interfaces.

“We are trying to grow a perioperative surgical home model in our greater anesthesia practice, and a big part of that process is capturing patient quality metrics in the postoperative setting,” Dr. Jacob said. “This study shows us that we have work to do to improve our practice, but the results have also provided a good platform to start with. The survey is creating a larger movement in our practice for better patient follow-up.”