Surgeon's experience as a factor for emetic sequelae after middle ear surgery.

PURPOSE

To test the hypothesis that an experienced surgeon is associated with less postoperative nausea and vomiting (PONV).

METHODS

A post hoc analysis was done on the data of 167 patients from 3 randomized studies on the prevention of PONV, with transdermal scopolamine, ondansetron and propofol, in middle ear surgery under general anaesthesia.

RESULTS

The patients in the residents' group suffered more from PONV (69% vs. 42%, P < 0.01) and from retching or vomiting (52% vs. 23%, P < 0.001) than those in the specialists' group. The proportion of patients needing droperidol was also higher in the residents' group (66% vs. 27%, P < 0.001). The durations of anaesthesia and surgery seemed to correlate positively with PONV. In matched-pair analysis, residentship was confirmed as a risk factor for emetic symptoms. In the residents' group, prophylaxis of PONV resulted in a decrease in retching and vomiting from 71% to 29% (P < 0.01), and in patients needing droperidol from 87% to 46% (P < 0.01).

CONCLUSION

The patients operated by residents need more aggressive prophylaxis for PONV than those operated by specialists in middle ear surgery.