TITLE:
Preoperative Concern about Nausea and Vomiting and Postoperative Use of Antiemetics among Patients Undergoing Breast Cancer-Related Surgery
AUTHORS:
John L. Raytis, Carolyn E. Behrendt, Richard Obenchain, Matthew Loscalzo, Michael W. Lew
KEYWORDS:
Antiemetics, Patient Generated Data, Postoperative Nausea and Vomiting
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.8 No.6,
June
29,
2018
ABSTRACT: Background: Postoperative nausea and vomiting (PONV) can lead to complications and
increased healthcare costs. We investigated whether patient preoperative
concern about PONV is associated with postoperative antiemetic use,
independently of Apfel score. Methods: Patients eligible for study were
English- or Spanish-speaking women with breast cancer undergoing mastectomy,
lumpectomy or reconstructive surgery as outpatients during July 2014-July 2017,
when the pre-anesthesia clinic routinely screened for preoperative concern via
tablet computer-based survey. Excluded were patients who did not rate their
concern or lacked Apfel score. Risk factors for concern were evaluated in a
multinomial model adjusted for multiple hypotheses. Using generalized linear
regression, preoperative concern was tested for association with number of antiemetics
administered in the postanesthesia care unit. Results:Of preoperative surveys, 7.1%
(58/812) were excluded for missing data, leaving n = 754 surveys contributed by
n = 706 subjects (age 26 - 80 years). Patient preoperative concern ranged from none
(32.8%), mild (30.2%), moderate (22.9%), severe (7.8%), to very severe (6.2%).
Adjusted for age, concern was increased by history of motion sickness (Odds
Ratio 1.51, 95% Confidence Interval 1.11 - 2.06) and history of PONV (9.02,
6.30 - 12.90) and decreased by prior surgery without PONV (0.35, 0.23 - 0.53)
and Spanish as primary language (0.42, 0.25 - 0.68). Number of postoperative
antiemetics, usually 1 (41.2%) or 2 (33.4%) drugs, was unassociated with
preoperative concern before or after adjustment for Apfel score. Conclusions: Among women undergoing breast cancer-related surgery, preoperative concern
about PONV varies by prior history of PONV and motion sickness and by
ethnicity. However, preoperative concern is not associated with postoperative
antiemetic medications.