Goldson Kareem V, Brennan Emily, Burton Brittany N, Faloye Abimbola O, Habermann Elizabeth B, Hanson Kristine T, Warner David O, Youssef Mohanad R, Milam Adam J
Mountain Area Health Education Center, Asheville, North Carolina.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
Anesthesiology. 2025 Apr 1;142(4):704-715. doi: 10.1097/ALN.0000000000005367. Epub 2025 Jan 9.
Disparities in postoperative nausea and vomiting and its prophylaxis may exist based on race, ethnicity, and socioeconomic status. The objective was to evaluate whether patients from racial and ethnic minority groups and patients from lower socioeconomic status backgrounds received less appropriate postoperative nausea and vomiting prophylaxis and experienced higher rates of postoperative and postdischarge nausea and vomiting.
This retrospective cohort study included 23,333 adults who underwent major surgeries (total knee arthroplasty, cholecystectomy, hysterectomy, and prostatectomy) from 2017 to 2022 in a single, multistate hospital system. Outcomes included prophylactic antiemetic administration according to consensus guidelines, as well as the occurrence of postoperative and postdischarge nausea and vomiting, with predictors being patient race and ethnicity, payor type, and community-level socioeconomic status.
About 45% (n = 10,407) of patients received guideline-recommended postoperative nausea and vomiting prophylaxis. Regression models showed statistically significant differences in appropriate postoperative nausea and vomiting prophylaxis by race and ethnicity, as well as community-level socioeconomic status, with Black (odds ratio, 0.76; 95% CI, 0.63 to 0.92) and Hispanic (odds ratio, 0.82; 95% CI, 0.70 to 0.96) patients having lower odds of receiving appropriate antiemetic prophylaxis compared to non-Hispanic White patients. Approximately 11% of patients (n = 2,522) experienced postoperative nausea and vomiting in the postanesthesia care unit, and about 19.5% of patients (n = 4,540) experienced postdischarge nausea and vomiting. No significant differences in postoperative nausea and vomiting were observed in the postanesthesia care unit among different groups; however, Black, Hispanic, other races and ethnicities, and patients with Medicaid had higher odds of postdischarge nausea and vomiting.
The study identified differences in appropriate postoperative nausea and vomiting prophylaxis by race and ethnicity, as well as community-level socioeconomic status. There were no differences in postoperative nausea and vomiting by the predictors, but there were higher odds of postdischarge nausea and vomiting by race and ethnicity and payor. This study underscores the importance of data stratification in quality measures to identify disparities in perioperative care; it can lead to changes in perioperative anesthetic management. Further research should explore these associations in a broader cohort and address potential confounding sources.
术后恶心呕吐及其预防措施可能因种族、民族和社会经济地位存在差异。目的是评估来自少数种族和民族群体的患者以及社会经济地位较低背景的患者是否接受了不太恰当的术后恶心呕吐预防措施，以及术后和出院后恶心呕吐的发生率是否更高。
这项回顾性队列研究纳入了2017年至2022年在一个单一的多州医院系统中接受大手术（全膝关节置换术、胆囊切除术、子宫切除术和前列腺切除术）的23333名成年人。结局包括根据共识指南进行预防性止吐药给药，以及术后和出院后恶心呕吐的发生情况，预测因素为患者的种族和民族、付款类型以及社区层面的社会经济地位。
约45%（n = 10407）的患者接受了指南推荐的术后恶心呕吐预防措施。回归模型显示，在术后恶心呕吐的恰当预防措施方面，种族和民族以及社区层面的社会经济地位存在统计学显著差异，与非西班牙裔白人患者相比，黑人（比值比，0.76；95%置信区间，0.63至0.92）和西班牙裔患者（比值比，0.82；95%置信区间，0.70至0.96）接受恰当止吐预防措施的几率较低。约11%（n = 2522）的患者在麻醉后护理单元经历了术后恶心呕吐，约19.5%（n = 4540）的患者经历了出院后恶心呕吐。不同组之间在麻醉后护理单元的术后恶心呕吐方面未观察到显著差异；然而，黑人、西班牙裔、其他种族和民族以及医疗补助患者出院后恶心呕吐的几率更高。
该研究确定了在术后恶心呕吐的恰当预防措施方面，种族和民族以及社区层面的社会经济地位存在差异。预测因素在术后恶心呕吐方面无差异，但种族和民族以及付款人导致出院后恶心呕吐的几率更高。这项研究强调了在质量指标中进行数据分层以识别围手术期护理差异的重要性；这可能会导致围手术期麻醉管理的改变。进一步的研究应在更广泛的队列中探索这些关联，并解决潜在的混杂因素。
