Retrospective analysis of the incidence and predictors of postoperative nausea and vomiting after orthopedic surgery under spinal anesthesia

Background: Postoperative nausea and vomiting (PONY) commonly occurs after spinal anesthesia; however, its incidence rate and predictors have been scarcely studied. There-fore, we aimed to investigate its incidence rate and potential predictors. Methods: The electronic medical records of 6,610 consecutive patients undergoing ortho-pedic surgery under spinal anesthesia were reviewed between January 2016 and December 2020. The primary outcome was PONY incidence within 24 h after spinal anesthesia. Along with its incidence rate, we investigated its predictors using multivariable logistic re-gression analysis. Results: Among the 5,691 patients included in the analysis, 1,298 (22.8%) experienced PONY within 24 h after spinal anesthesia. Female sex (odds ratio [OR]: 3.23, 95% CI [2.72, 3.83], P < 0.001), nonsmoker (OR: 2.12, 95% CI [1.46, 3.07], P < 0.001), history of PONY (OR: 1.52, 95% CI [1.26, 1.82], P < 0.001), prophylactic 5-hydroxytryptamine re-ceptor antagonist use (OR: 0.35, 95% CI [0.24, 0.50], P < 0.001), prophylactic steroid use (OR: 0.53, 95% CI [0.44, 0.62], P < 0.001), baseline heart rate >= 60 beats/min (OR: 1.38, 95% CI [1.10, 1.72], P = 0.005), and postoperative opioid use (OR: 2.57, 95% CI [1.80, 3.67], P < 0.001), were significant predictors of the primary outcome. Conclusions: Our study showed the common incidence of PONY after spinal anesthesia and its significant predictors. A better understanding of its predictors may provide import-ant information for its management.

Automated summary

This study investigated the incidence rate and predictors of postoperative nausea and vomiting (PONY) after spinal anesthesia in 6,610 patients undergoing orthopedic surgery. The results showed that 22.8% of patients experienced PONY within 24 hours after spinal anesthesia. Female sex, nonsmoker, history of PONY, prophylactic use of 5-hydroxytryptamine receptor antagonists and steroids, baseline heart rate >= 60 beats/min, and postoperative opioid use were significant predictors of PONY.