A Postoperative PONV Risk-Stratified Nursing Pathway for Early Oral Intake and Quality of Recovery After Adult Bimaxillary Orthognathic Surgery

Postoperative nausea and vomiting (PONV) can interfere with oral intake and early recovery after bimaxillary orthognathic surgery. This single-centre, prospective, parallel-group, outcome-assessor-blinded randomized controlled trial evaluated a postoperative PONV risk-stratified nursing pathway in 180 adults undergoing Le Fort I osteotomy combined with bilateral sagittal split osteotomy. Patients were allocated 1:1 to usual care or risk-stratified nursing. Surgery, anaesthesia and postoperative analgesia followed the same institutional principles in both groups. The intervention comprised Apfel score-based symptom surveillance, structured nursing management of PONV, and a readiness-based stepwise oral-intake pathway after the routine 6-hour postoperative fasting period. The primary outcome was the 24-hour Quality of Recovery-15 (QoR-15) score. Overall 0-hour to 24-hour PONV incidence did not differ significantly between the risk-stratified nursing and usual-care groups (46.7% versus 51.1%; relative risk, 0.91; 95% CI: 0.68–1.23; P =0.551). Moderate-to-severe nausea was less frequent with risk-stratified nursing (12.2% versus 27.8%; relative risk, 0.44; 95% CI: 0.23–0.84; P =0.009). The intervention group achieved successful oral intake earlier [7.2 (6.7, 7.8) versus 7.8 (7.4, 8.3) h; P <0.001], had greater 6-hour to 12-hour and 0-hour to 24-hour intake, and fewer PONV-related feeding interruptions. The adjusted between-group difference in 24-hour QoR-15 was 5.9 points (95% CI: 3.5–8.2; P <0.001). A postoperative PONV risk-stratified nursing pathway improved symptom burden, oral intake recovery, and patient-reported early recovery after bimaxillary orthognathic surgery.