Real‐World Impact on Postoperative Vomiting by Changing Anesthesia Regimens in Children Undergoing Strabismus Surgery: An Interrupted Time Series Analysis

Background Preventive measures for postoperative vomiting (POV) in pediatric strabismus surgery are essential. Previous experimental studies have shown the independent antiemetic effects of propofol‐based total intravenous anesthesia (TIVA), dexamethasone (DEX), and ondansetron (OND). However, the real‐world outcomes of POV following the combined use of DEX and OND with propofol/opioid TIVA remain unknown. Aims To evaluate the longitudinal incidence of POV across three phases of different anesthesia regimens. Methods This retrospective observational study was conducted at a single tertiary‐care children's hospital in Japan, including children aged < 18 years who underwent strabismus surgery and had no major comorbidities. The primary outcome was either POV or the use of antiemetics within 24 h or by discharge. Changes in the levels and time‐trend slopes of POV were evaluated using interrupted time series analysis among three phases: (1) sevoflurane with pentazocine, (2) propofol/opioid TIVA with DEX, and (3) propofol/opioid TIVA with DEX and OND. Results Of the 2378 children, the POV incidence in Phases 1, 2, and 3 was 109/471 (23.1%), 87/1260 (6.9%), and 28/647 (4.3%), respectively ( p < 0.001). A significant level change in POV occurrence was observed from Phase 1 to Phase 2, while no significant level change was found from Phase 2 to Phase 3. The time‐trend changes in POV occurrence showed no significant difference during Phases 2 and 3. Conclusions Real‐world departmental‐level data showed a decrease in POV occurrence after transitioning from sevoflurane‐based anesthesia with pentazocine to propofol/opioid TIVA with DEX. However, no significant decrease in POV occurrence was found by adding OND to propofol/opioid TIVA with DEX. Further studies are needed to improve the generalizability of evaluating the real‐world antiemetic effect of combining antiemetic medications on propofol/opioid TIVA.