Incidence and predictors of postoperative nausea and vomiting after laparoscopic cholecystectomy: a prospective observational study in Nepal.

Abstract

Purpose: The incidence of postoperative nausea and vomiting (PONV) is variable across different settings. In our setting, no standardized risk assessment strategies exist, leading to sporadic use of antiemetics. This study aims to assess the incidence of PONV in adult patients undergoing laparoscopic cholecystectomy (LC), its predictors, and the effectiveness of the Apfel score and Koivuranta score in predicting PONV after LC in Nepalese patients.

Methods: A prospective observational study was conducted among patients undergoing elective LC. Apfel score and Koivuranta score were calculated for each patient. Postoperatively, patients were monitored for nausea and vomiting for 24 hours. Bivariate and multivariate analyses were performed to find the predictors. The receiver operating characteristic (ROC) curve was constructed to compare the scores.

Results: A total of 100 patients were analyzed with mean age of 36 years and female predominance (82%). The mean hospital stay was 2.51 days. Incidence of PONV was 43%. Absence of smoking (odds ratio [OR], 7.66; 95% confidence interval [CI], 1.91-30.78), history of motion sickness (OR, 9.51; 95% CI, 2.63-34.38), and use of postoperative opioids (OR, 7.18; 95% CI, 2.24-23.01) were significantly associated with PONV. The Apfel score (area under the curve [AUC] of 0.809) had slightly superior performance than Koivuranta score (AUC of 0.79).

Conclusion: There is a higher incidence of PONV after LC, with a higher risk in nonsmokers, patients with history of motion sickness, and use of postoperative opioids. Apfel score is an accurate and simpler score than Koivuranta score that can be used for the risk stratification of these patients.