A time-motion economic analysis of postoperative nausea and vomiting in ambulatory surgery.
BACKGROUND
One-third of surgical outpatients experience postoperative nausea and vomiting (PONV) during their hospital stay or post-discharge nausea and vomiting (PDNV) after hospitalization. We determined the incremental costs of PONV/PDNV in ambulatory patients with this time-and-motion study.


METHODS
In 100 ambulatory surgery patients, we evaluated the incidence of PONV, time staff spent with patients, use of PONV-related supplies, recovery duration, PONV rescue treatments, and quality-of-life through to the third postoperative morning. Patients with and without PONV/PDNV were compared in relation to PONV-related cost after adjusting for age, American Society of Anesthesiologists status, body mass index, and duration and complexity of surgery.


RESULTS
Thirty-seven percent of the patients experienced PONV during hospitalization; this increased to 42% by the first postoperative morning and increased further to 49% by the third postoperative morning. Patients with PONV spent one hour longer in the postanesthesia care unit than patients without PONV (median [interquartile range] 234 [188-287] min vs 171 [144-212] min, respectively; P = 0.001). The amount of nursing time required for patients with PONV was significantly greater than that required for patients without PONV (82 [63-106] min vs 68 [57-79] min, respectively; P = 0.02). The total cost of postoperative recovery was significantly greater for patients with PONV/PDNV than for those without (US$730 vs $640, respectively; P = 0.006). Postoperative nausea and vomiting/PDNV was associated with an adjusted incremental total cost of $75 (95% confidence interval $67 to $86). Postoperative nausea and vomiting was also associated with worsened postoperative quality of life (49% of patients with PONV/PDNV rated quality high in four domains vs 94% of patients without PONV/PDNV; P < 0.001).


CONCLUSIONS
Postoperative nausea and vomiting/PDNV were common; they impaired quality of life and imposed an incremental cost of $75 per patient. This incremental cost is comparable with the cost patients are willing to pay to avoid PONV.
Department of Outcomes Research, Anesthesiology Institute, The Cleveland Clinic-P77, Cleveland, OH 44195, USA.
Ivan
I
Parra-Sanchez
Rania
R
Abdallah
Jing
J
You
Alex Z
AZ
Fu
Martin
M
Grady
Kenneth
K
Cummings
Christian
C
Apfel
Daniel I
DI
Sessler
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000191:economics* / Q000451:nursing / Q000523:psychology; D011788:Quality of Life; D013997:Time Factors