Operation-specific risk of postoperative nausea: a cross-sectional study comparing 72 procedures.

Objectives: Determination of the procedure-specific, risk-adjusted probability of nausea.
Design: Cross-sectional analysis of clinical and patient-reported outcome data. We used a logistic regression model with type of operation, age, sex, preoperative opioids, antiemetic prophylaxis, regional anaesthesia, and perioperative opioids as predictors of postoperative nausea.
Setting: Data from 152 German and Austrian hospitals collected in the Quality Improvement in Postoperative Pain Treatment (QUIPS) registry from 2013 to 2022. Participants completed a validated outcome questionnaire on the first postoperative day. Operations were categorised into groups of at least 100 cases.
Participants: We included 78 231 of the 293 947 participants from the QUIPS registry. They were 18 years or older, willing and able to participate and could be assigned to exactly one operation group.
Main Outcome Measures: Adjusted absolute risk of nausea on the first postoperative day for 72 types of operation.
Results: The adjusted absolute risk of nausea ranged from 6.2% to 36.2% depending on the type of operation. The highest risks were found for laparoscopic bariatric operations (36.2%), open hysterectomy (30.4%), enterostoma relocation (29.8%), open radical prostatectomy (28.8%), laparoscopic colon resection (28.6%) and open sigmoidectomy (28%). In a logistic regression model, male sex (OR: 0.39, 95% CI 0.37 to 0.41, p<0.0001), perioperative nausea and vomiting prophylaxis (0.73, 0.7 to 0.76, p<0.0001), intraoperative regional anaesthesia (0.88, 0.83 to 0.93, p<0.0001) and preoperative opioids for chronic pain (0.74, 0.68 to 0.81, p<0.0001) reduced the risk of nausea. Perioperative opioid use increased the OR up to 2.38 (2.17 to 2.61, p<0.0001).
Conclusions: The risk of postoperative nausea varies considerably between surgical procedures. Patients undergoing certain types of operation should receive special attention and targeted prevention strategies. Adding these findings to known predictive tools may raise awareness of the still unacceptably high incidence of nausea in certain patient groups. This may help to further reduce the prevalence of nausea.
Trial Registration Number: DRKS00006153; German Clinical Trials Register; https://drks.de/search/de/trial/DRKS00006153.
Competing Interests: Competing interests: All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years: PK received consulting fees and payment for lectures from TEVA Ratiopharm, Sintetica, Amicus Ltd., Fresenius Kabi, CSL Bering, Vifor and Pajunk; WM received consultation fees and payment for lectures from Mundipharma Int., Ethypharm, Grünenthal, Kyowa, Spectrum Therapeutics. His institution has received research funding from Pfizer, Grünenthal, Mundipharma Int. other relationships or activities that could appear to have influenced the submitted work: PK had leading roles in ESAIC Chairman of the Guideline Committee and PONV Consensus Conference Member (ASER, SAMBA).
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