Factors Associated with Postoperative Nausea and Vomiting in Patients Undergoing an Ambulatory Hand Surgery

BACKGROUND: Patients undergoing ambulatory surgery under general anesthesia experience considerable levels of postoperative nausea and vomiting (N/V) after their discharge. However, those complications have not been thoroughly investigated in hand surgery patients yet. We investigated factors associated with postoperative N/V in patients undergoing an ambulatory hand surgery under general anesthesia and determined whether patients' satisfaction with this setting is associated with postoperative N/V levels. METHODS: We prospectively evaluated 200 consecutive patients who underwent ambulatory hand surgeries under general anesthesia to assess their postoperative N/V visual analogue scale (VAS) levels during the first 24 hours after surgery and their satisfaction with an ambulatory surgery setting. Potential predictors of postoperative N/V were; age, sex, body mass index, smoking behavior, a history of postoperative N/V after previous anesthesia or motion sickness, preoperative anxiety level and the duration time of anesthesia. We conducted multivariate analyses to identify factors associated with postoperative N/V levels. We also conducted multivariate logistic regression analyses to determine whether the N/V levels are associated with the patients' satisfaction with this setting. Here, potential predictors for satisfaction were sex, age, postoperative pain and N/V. RESULTS: Postoperative N/V were associated with a non-smoking history, a history of motion sickness and a high level of preoperative anxiety. Twenty-two patients (11%) were dissatisfied with the ambulatory setting and this dissatisfaction was independently associated with moderate (VAS 4-7) and high (VAS 8-10) levels of postoperative N/V and with a high level (VAS 8-10) of postoperative pain. CONCLUSIONS: Although most of the patients were satisfied with the ambulatory surgery setting, moderate to high levels of N/V were associated with dissatisfaction of patients with this setting, suggesting a need for better identifying and managing those patients at risk. The information regarding risk factors for N/V could help in preoperative patient consultation regarding an ambulatory hand surgery under general anesthesia.

Náusea e vômito no pós-operatório: validação da versão em português da escala de intensidade de náuseas e vômitos pós-operatórios / Postoperative nausea and vomiting: validation of the portuguese version of the postoperative nausea and vomiting intensity score / Náusea y vómito en el postoperatorio: validación de la versión en portugués de la escala de intensidad de náuseas y vómitos postoperatorios

JUSTIFICATIVA E OBJETIVO: A Escala de Intensidade de Náuseas e Vômitos Pós-Operatórios (NVPO) foi desenvolvida para definir NVPOs clinicamente importantes. O objetivo deste estudo foi traduzir, retraduzir e validar a Escala de Intensidade de NVPO para uso em unidades de recuperação pósanestésica (RPA) portuguesas. MÉTODO: A Escala de Intensidade de NVPO foi traduzida e retraduzida de acordo com as diretrizes disponíveis. A equipe de pesquisadores conduziu um estudo prospectivo e observacional de coorte em uma RPA. Durante três semanas, avaliamos as NVPO em 157 pacientes adultos internados após cirurgia. As mensurações foram feitas com o uso da Escala Visual Analógica (EVA) nos intervalos de seis e 24 horas durante o período pós-operatório. Avaliamos a confiabilidade e a discordância do observador com o uso do coeficiente de correlação interclasses (CCI) e da medida de discordância baseada na informação (MDBI). Comparamos os escores EVA entre os pacientes com NVPO clinicamente significantes (> 50) e não significantes (< 50). RESULTADOS: Trinta e nove pacientes (25%) apresentaram NVPO em seis horas e 54 (34%) em 24 horas. Trinta e seis pacientes apresentaram náusea em seis horas e 54 em 24 horas. Entre os pacientes com NVPO, os escores de seis pacientes (15%) e nove pacientes (27%) foram clinicamente significantes na Escala de Intensidade de NVPO em seis e 24 horas, respectivamente. A confiabilidade foi boa tanto para os escores da Escala de Intensidade de NVPO quanto para EVA e a discordância entre observadores foi ligeiramente superior para EVA. A mediana dos escores EVA foi maior nos pacientes com escores clinicamente significantes na Escala de Intensidade de NVPO. CONCLUSÃO: A Escala de Intensidade de NVPO parece ser um instrumento de avaliação e monitoramento preciso e confiável de NVPO em RPA.

BACKGROUND AND OBJECTIVES: The Postoperative Nausea and Vomiting (PONV) Intensity Scale was developed to define clinically important PONV. The aim of this study was to translate, retranslate and validate the PONV Intensity Scale for use in Portuguese Post Anesthetic Care Unit (PACU) settings. METHODS: The PONV Intensity Scale was translated and back-translated in accordance with available guidelines. The research team conducted an observational and cohort prospective study in a PACU. One-hundred fifty-seven adult patients admiited after surgery over three weeks were evaluated for PONV. Measurements included nausea visual analogic scale (VAS) at 6 and 24 hours, postoperatively. We assessed reliability and observer disagreement using interclass correlation (ICC) and Information-Based Measure of Disagreement (IBMD). We compared VAS scores between patients with clinically significant (>50) and not significant (<50) PONV. RESULTS: Thirty-nine patients (25%) had PONV at 6 hours and 54 (34%) had PONV at 24 hours. Thirty-six and 54 patients experienced nausea at 6 and 24 hours, respectively. Among patients with PONV, 6 patients (15%) and 9 patients (27%) had a clinically significant PONV intensity scale score at 6 and at 24 hours, respectively. The reliability was good both for PONV intensity scale score and for VAS and observer disagreement was slightly higher for VAS. The median nausea VAS scores were higher in patients with clinically significant PONV Intensity score. CONCLUSIONS: The PONV Intensity Scale appears to be an accurate and reliable assessment and monitoring instrument for PONV in the PACU settings.

JUSTIFICATIVA Y OBJETIVO: La Escala de Intensidad de Náuseas y Vómitos Postoperatorios (NVPO) ha venido siendo desarrollada para definir NVPOs clínicamente importantes. El objetivo de este estudio fue traducir, re-traducir y validar la Escala de Intensidad de NVPO para el uso en las unidades de recuperación postanestésica (Urpa) portuguesas. MÉTODO: La Escala de Intensidad de NVPO fue traducida y retraducida a tono con las directrices que están disponibles. El equipo de investigadores llevó a cabo un estudio prospectivo y observacional de cohorte en una Urpa. Durante tres semanas, evaluamos el NVPO de 157 pacientes adultos ingresados despues de cirugía. Las mensuraciones se hicieron usando la Escala Visual Analógica (EVA) en los intervalos de seis y 24 horas durante el período Postoperatorio. Evaluamos la confiabilidad y la discordancia del observador con el uso del coeficiente de correlación inter-clases (CCI) y de la medida de discordancia con base en la información (MDBI). Comparamos las puntuaciones EVA entre los pacientes con NVPO clínicamente significativas (> 50) y no significativas (< 50). RESULTADOS: Treinta y nueve pacientes (25%) tuvieron NVPO en seis horas y 54 (34%) en 24 horas. Treinta y seis pacientes tuvieron náusea en seis horas y 54 en 24 horas. Entre los pacientes con NVPO, las puntuaciones de seis pacientes (15%) y nueve pacientes (27%) fueron clínicamente significativas en la Escala de Intensidad de NVPO en seis y 24 horas, respectivamente. La confiabilidad fue buena tanto para las puntuaciones de la Escala de Intensidad de NVPO como para EVA, y la discordancia entre los observadores fue ligeramente superior para EVA. La mediana de las puntuaciones EVA fue mayor en los pacientes con puntuaciones clínicamente significativas en la Escala de Intensidad de NVPO. CONCLUSIONES: La Escala de Intensidad de NVPO parece ser un instrumento de evaluación y monitoreo preciso y confiable de NVPO en las URPAs.