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

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.