Post-operative nausea and vomiting prophylaxis in adult day case surgery : did it justify a local protocol?

Abstract

Background: Post-operative nausea and vomiting (PONV) is common following surgery and results in complications. The Society of Ambulatory Anaesthesia (SAMBA) published internationally established guidelinesfor its prophylaxis. Our aim was to investigate whether guidelines were being followed locally. We also assessed incidence of PONV, delay in discharge or unplanned admissions in adult surgical cases at Day Care Unit. This study was repeated after five yearsto assess the impact of establishing local guidelines in Mater Dei Hospital in the same year.

Methods: In this retrospective study,we collected information between August and September 2012 and then in 2017. Data regarding vomiting, delayed discharge or unplanned admission due to PONV was documented. Local guidelines were implemented in 2013. Educational measures to raise awareness were carried out, followed by a re-audit in 2017.

Results: 195 patients were eligible in the first study and 173 in the second cycle. No statistically significant decrease was found between patients having PONV (12.4%and 10% in the re-audit - p<0.01). One in ten patients (1%) had an unplanned admission due to PONV during the first audit with no admissions in the second study. Number of risk factors for PONV did not correlate with anti-emetics given.

Conclusion: The incidence of PONV in adult day cases at our day care unit justifies the use of protocol for better prophylaxis. However, local protocols are not being followed. Education and emphasis of local guidelines can improve the compliance rate.