Real-World Incidence and Determinants of Postoperative Nausea and Vomiting in Adult Surgical Patients: A Retrospective Cohort Study

Introduction Despite the availability of effective antiemetic prophylactic strategies, postoperative nausea and vomiting (PONV) is a prevalent and distressing complication following anesthesia. Understanding the real-world data on incidence of PONV, risk factors, and adherence to prophylaxis protocols is essential for enhancing perioperative care. Objectives The objective of this is to determine the incidence of PONV, identify risk factors, assess the effectiveness of prophylactic antiemetic use, and assess adherence to institutional prophylactic antiemetic policy. Method This was a retrospective observational study on adult patients (≥18 years) undergoing inpatient surgery under general anesthesia. Data on patient demographics, Apfel risk factors, anesthesia and surgical details, antiemetic use, and PONV occurrence were retrieved from an institutional electronic database. Results A total of 1113 patients were analysed. The overall incidence of PONV within 24 hours after surgery was 17.9%. Patients with PONV had significantly higher ASA scores (2.6 ± 0.9 vs 2.2 ± 0.8; p <0.001), longer anesthesia duration (148.4 ± 100.6 minutes vs 127.8 ± 77.7 minutes; p =0.002), and higher Apfel scores (2.5 ± 0.7 vs 2.4 ± 0.7; p =0.032). Intraoperative antiemetic prophylaxis was associated with a significantly lower PONV incidence compared with no prophylaxis (16.9% vs 39.2%; p <0.001). Conclusion Patient-related factors, particularly female sex and higher Apfel score, were key determinants of PONV. Perioperative prophylaxis significantly reduced the risk of PONV. Improved adherence to institutional multimodal prophylaxis protocols may further reduce PONV and enhance postoperative recovery.