Use of Aprepitant and Factors Associated With Incidence of Postoperative Nausea and Vomiting in Patients Undergoing Facial Plastic Surgery.

IMPORTANCE

Patients who experience immediate postoperative nausea and vomiting (PONV) after their facial plastic surgery procedure have a higher incidence of complications and dissatisfaction.

OBJECTIVES

To determine whether a single dose of aprepitant administered preoperatively can decrease the incidence of immediate PONV in patients undergoing facial plastic surgery compared with patients who are administered ondansetron hydrochloride alone and whether patient-related factors pose a greater risk of developing immediate PONV after surgery.

DESIGN, SETTING, AND PARTICIPANTS: In this retrospective study, we reviewed 172 patients undergoing facial plastic surgery with general anesthesia at an accredited office-based surgery practice from January 1, 2012, through December 31, 2013.

INTERVENTIONS

All patients received prophylactic treatment to mitigate against immediate PONV. Fifty-six patients received aprepitant in addition to ondansetron as prophylaxis for PONV.

MAIN OUTCOMES AND MEASURES

Patients undergoing facial plastic surgery were assessed during the immediate postoperative period for PONV. In addition, patient age, type of procedure, duration of surgery, and sex were reported.

RESULTS

The addition of aprepitant preoperatively effectively reduced the PONV rate from 15.5% to 1.8% (P = . 02). Logistic regression analysis revealed that duration of surgery longer than 90 minutes (odds ratio [OR], 2.936; 95% CI, 0.560-15.385; P = .20), female sex (OR, 1.893; 95% CI, 0.379-9.448; P = .44), and type of procedure increased the likelihood of PONV after facial plastic surgery with an odds ratio of greater than 1 in this sample population. However, the odds ratios were not statistically significantly greater than 1 for the 95% CIs. Of the 19 patients who experienced PONV, 17 were women, and 17 patients had a duration of surgery longer than 90 minutes. Patient age did not appear to affect the rate of PONV (P = .32).

CONCLUSIONS AND RELEVANCE

Preoperative aprepitant administered within 1 hour before facial plastic surgery in patients at risk of developing PONV effectively reduce the rate of immediate PONV. Female patients and patients with facial surgery duration of longer than 90 minutes might benefit from the added expense of aprepitant to further reduce the likelihood of PONV.

LEVEL OF EVIDENCE