Portnoy Yotam, Glebov Maxim, Orkin Dina, Katsin Maksim, Berkenstadt Haim
From the Arrow Program for Medical Research Education, Chaim Sheba Medical Center, Ramat Gan, Israel.
First Faculty of Medicine, Charles University in Prague, Czechia.
Anesth Analg. 2025 Jul 1;141(1):77-85. doi: 10.1213/ANE.0000000000007291. Epub 2024 Nov 19.
Postoperative nausea and vomiting (PONV) in pediatric patients is a common and clinically significant postoperative complication. The incidence of PONV has not been extensively studied in large pediatric cohorts. Furthermore, in 2020, the Fourth Consensus Guidelines for the management of PONV were published. However, the association between perioperative factors and adherence to these guidelines remains unclear. This study aims to assess both the incidence of PONV and guideline adherence within a large and diverse pediatric population.
We conducted a retrospective observational study at a large tertiary medical center, including pediatric patients (≤18 years) who underwent surgery between September 2020 and March 2023. We conducted a retrospective analysis of data from our electronic health records, focusing on patient demographics, surgical details, anesthesia details, and prophylaxis for PONV. We calculated the incidence of PONV and used multivariable logistic regression to identify the predictors of guideline adherence.
The cohort included 3772 patients with a median (interquartile range [IQR]) age of 9.21 (3.55-14.68) years. The incidence (95% confidence intervals) of early PONV was 1.0% (0.7-1.4) and 3.8% (3.2-4.5) for delayed PONV. Adherence to the fourth consensus guidelines for PONV management was observed in 32.5% (31.0-34.0) of cases. A high risk of PONV was identified in 55.9% (54.3-57.5) of the patients. The most common number of PONV risk factors was 3, observed in 1151 patients (30.5% [29.1-32.0]). Significant predictors of guideline adherence included the intraoperative use of long-acting opioids (odds ratio [OR], 2.711, P < .001) and age ≥3 years (OR, 2.074, P < .001). Nonadherence was associated with a higher incidence of PONV at 24 hours postsurgery (4.4% (3.6-5.2) vs 2.7% (1.9-3.8), P = .012). Factors such as specific high PONV risk surgeries ( P = .001), maintenance with inhalational agents solely ( P = .017), and neostigmine use ( P < .001) were also all statistically significant.
Our study revealed a lower-than-expected incidence of PONV in pediatric patients, highlighting the need for standardized definitions and improved reporting. Adherence to PONV guidelines was suboptimal, emphasizing the need for better implementation strategies.
小儿患者术后恶心呕吐（PONV）是一种常见且具有临床意义的术后并发症。在大型儿科队列中，尚未对PONV的发生率进行广泛研究。此外，2020年发布了第四版PONV管理共识指南。然而，围手术期因素与这些指南依从性之间的关联仍不清楚。本研究旨在评估大型多样化儿科人群中PONV的发生率和指南依从性。
我们在一家大型三级医疗中心进行了一项回顾性观察研究，纳入了2020年9月至2023年3月期间接受手术的儿科患者（≤18岁）。我们对电子健康记录中的数据进行了回顾性分析，重点关注患者人口统计学、手术细节、麻醉细节和PONV预防措施。我们计算了PONV的发生率，并使用多变量逻辑回归来确定指南依从性的预测因素。
该队列包括3772例患者，中位（四分位间距[IQR]）年龄为9.21（3.55 - 14.68）岁。早期PONV的发生率（95%置信区间）为1.0%（0.7 - 1.4），延迟性PONV为3.8%（3.2 - 4.5）。在32.5%（31.0 - 34.0）的病例中观察到对第四版PONV管理共识指南的依从性。55.9%（54.3 - 57.5）的患者被确定为PONV高风险。最常见的PONV风险因素数量为3个，在1151例患者中观察到（30.5%[29.1 - 32.0]）。指南依从性的显著预测因素包括术中使用长效阿片类药物（比值比[OR]，2.711，P <.001）和年龄≥3岁（OR，2.074，P <.001）。不依从与术后24小时PONV的较高发生率相关（4.4%（3.6 - 5.2）对2.7%（1.9 - 3.8），P =.012）。特定的高PONV风险手术（P =.001）、仅使用吸入性药物维持（P =.017）和使用新斯的明（P <.001）等因素也均具有统计学意义。
我们的研究显示小儿患者中PONV的发生率低于预期，突出了标准化定义和改进报告的必要性。对PONV指南的依从性欠佳，强调了更好的实施策略的必要性。
