title: Incidence and predictors of postdischarge nausea and vomiting in a 7-day population.
abstract: OBJECTIVE
  1) To quantify the incidence and severity of postdischarge nausea and vomiting (PDNV) for 7 days in adults undergoing outpatient surgeries with general anesthesia; 2) to evaluate whether a risk model previously developed for the first two postoperative days may be used to predict the patient's risk of PDNV for 7 days; and 3) to verify whether the same risk factors are applicable in the 3 to 7 day period.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Two university-affiliated centers.
  
  
  METHODS
  248 adult (>18 years) surgical outpatients undergoing ambulatory surgical procedures with general anesthesia between 2007 and 2008.
  
  
  METHODS
  The incidence and severity of PDNV and a simplified risk score for PDNV was assessed prospectively from discharge up to 7 postoperative days.
  
  
  RESULTS
  The overall incidence of nausea was 56.9% and of emesis was 19.4%. The incidence of PDNV was highest on the day of surgery (DOS), with PDNV of 44.8% and decreasing over time to 6.0% on day 7. Using the simplified risk score for PDNV the area under the receiver operating characteristic (ROC) curve was 0.766 (0.707, 0.825). A previous history of postoperative nausea and vomiting (PONV; OR 3.51, CI 1.70 - 7.27), operating room time (odds ratio [OR] 2.19, 95% CI 1.34 - 3.60), use of ondansetron in the Postanesthesia Care Unit (PACU; OR 6.39, CI 1.65-24.79), and pain during days 3-7 (OR 1.67, CI 1.30 - 2.14) were the strongest predictors of PDNV on days 3-7.
  
  
  CONCLUSIONS
  PDNV affects a significant number of patients after ambulatory surgery, and our simplified PDNV score may be applied to a 7-day population. Pain appears to be a factor in late PDNV. It is possible that the presence of PDNV during days 3-7 has different origins from the PDNV that resolved over the first 48 hours.
authors.affiliation: College of Nursing, University of Kentucky, Lexington, KY 40536, USA. Electronic address: Jlforr2@uky.edu.
authors.forename: Jan
authors.initials: J
authors.lastname: Odom-Forren
authors.forename: Leena
authors.initials: L
authors.lastname: Jalota
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
authors.forename: Lynne A
authors.initials: LA
authors.lastname: Hall
authors.forename: Joseph
authors.initials: J
authors.lastname: Holtman
authors.forename: Vallire
authors.initials: V
authors.lastname: Hooper
authors.forename: Christian C
authors.initials: CC
authors.lastname: Apfel
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D000768:Anesthesia, General / Q000379:methods; D000932:Antiemetics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D017294:Ondansetron / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000453:epidemiology*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology*; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000932:Antiemetics; D017294:Ondansetron
keywords: Ambulatory surgery; Emesis control; Ondansetron; Outpatient anesthesia; Postdischarge nausea and vomiting