University of Utah, Department of Surgery, 30 North 1900 East, Salt Lake City, UT 84132, United States.
University of Utah, Department of Surgery, 30 North 1900 East, Salt Lake City, UT 84132, United States.
J Plast Reconstr Aesthet Surg. 2022 Feb;75(2):528-535. doi: 10.1016/j.bjps.2021.09.059. Epub 2021 Oct 22.
Mastectomy with immediate reconstruction is a high-risk cohort for postoperative nausea and vomiting (PONV). Known risk factors for PONV include female gender, prior PONV history, nonsmoker, age < 50, and postoperative opioid exposure. The objective of this observational, cohort analysis was to determine whether a standardized preoperative protocol with nonopioid and anti-nausea multimodal medications would reduce the odds of PONV.
After IRB approval, retrospective data were collected for patients undergoing mastectomy with or without a nodal resection, and immediate subpectoral tissue expander or implant reconstruction. Patients were grouped based on treatment: those receiving the protocol - oral acetaminophen, pregabalin, celecoxib, and transdermal scopolamine (APCS); those receiving none (NONE), and those receiving partial protocol (OTHER). Logistic regression models were used to compare PONV among treatment groups, adjusting for patient and procedural variables.
Among 305 cases, the mean age was 47 years (21-74), with 64% undergoing a bilateral procedure and 85% having had a concomitant nodal procedure. A total of 44.6% received APCS, 30.8% received OTHER, and 24.6% received NONE. The APCS group had the lowest rate of PONV (40%), followed by OTHER (47%), and NONE (59%). Adjusting for known preoperative variables, the odds of PONV were significantly lower in the APCS group versus the NONE group (OR=0.42, 95% CI: 0.20, 0.88 p = 0.016).
Premedication with a relatively inexpensive combination of oral non-opioids and an anti-nausea medication was associated with a significant reduction in PONV in a high-risk cohort. Use of a standardized protocol can lead to improved care while optimizing the patient experience.
乳房切除术加即刻重建是术后恶心呕吐（PONV）的高危人群。PONV 的已知危险因素包括女性、PONV 病史、不吸烟、年龄<50 岁和术后阿片类药物暴露。本观察性队列分析的目的是确定是否使用非阿片类和止吐多模式药物的标准化术前方案会降低 PONV 的可能性。
在 IRB 批准后，回顾性收集了接受乳房切除术和（或）淋巴结切除术、即刻胸肌下组织扩张器或植入物重建的患者的数据。根据治疗方法将患者分为三组：接受方案治疗（口服对乙酰氨基酚、普瑞巴林、塞来昔布和透皮东莨菪碱（APCS））的患者（APCS 组）；未接受任何治疗（NONE 组）的患者；以及接受部分方案治疗（OTHER 组）的患者。使用逻辑回归模型比较各组患者的 PONV 发生率，调整患者和手术变量。
在 305 例患者中，平均年龄为 47 岁（21-74 岁），64%接受双侧手术，85%接受淋巴结切除术。共有 44.6%的患者接受 APCS 治疗，30.8%的患者接受 OTHER 治疗，24.6%的患者接受 NONE 治疗。APCS 组 PONV 发生率最低（40%），其次是 OTHER 组（47%）和 NONE 组（59%）。调整已知术前变量后，APCS 组与 NONE 组相比，PONV 的可能性显著降低（OR=0.42，95%CI：0.20，0.88，p=0.016）。
高危人群中，预先使用相对廉价的口服非阿片类药物和止吐药物联合治疗与 PONV 发生率显著降低相关。使用标准化方案可改善护理，同时优化患者体验。
